Basic Information
| Provider Information | |||||||||
| NPI: | 1659772267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUCCIO | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16605 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 285 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813130031 | ||||||||
| FaxNumber: | 2813130032 | ||||||||
| Practice Location | |||||||||
| Address1: | 16605 SOUTHWEST FWY | ||||||||
| Address2: | SUITE 285 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774793501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813130031 | ||||||||
| FaxNumber: | 2813130032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2014 | ||||||||
| LastUpdateDate: | 04/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA09934 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 8393NM | 01 | TX | BCBSTX | OTHER |