Provider Demographics
NPI:1649677360
Name:CHICA, EDGAR ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:ANDRES
Last Name:CHICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6612 HERITAGE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8124
Mailing Address - Country:US
Mailing Address - Phone:516-448-2803
Mailing Address - Fax:
Practice Address - Street 1:3751 DEL REY BOULEVARD
Practice Address - Street 2:MESILLA VALLEY HOSPITAL
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012
Practice Address - Country:US
Practice Address - Phone:575-382-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-14292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry