Provider Demographics
NPI:1831062140
Name:MARCUCCI, CHLOE TAEKO (STUDENT INTERN)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:TAEKO
Last Name:MARCUCCI
Suffix:
Gender:F
Credentials:STUDENT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 THOUSAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3312
Mailing Address - Country:US
Mailing Address - Phone:210-491-9976
Mailing Address - Fax:866-557-2545
Practice Address - Street 1:2929 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3312
Practice Address - Country:US
Practice Address - Phone:210-491-9976
Practice Address - Fax:866-557-2545
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45386390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program