Provider Demographics
NPI:1861699621
Name:CHASE, CRAIG (PA-C)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:CHASE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 E EDGECOMB ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2203
Mailing Address - Country:US
Mailing Address - Phone:626-965-2334
Mailing Address - Fax:626-964-6504
Practice Address - Street 1:18710 AMAR RD STE A
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4571
Practice Address - Country:US
Practice Address - Phone:626-522-6553
Practice Address - Fax:844-400-1763
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13105363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13105OtherPA STATE LICENSE