Provider Demographics
NPI:1174785489
Name:NICORA BIA, MARIA M (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:M
Last Name:NICORA BIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:M
Other - Last Name:NICORA-GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2965 EAST ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3481
Mailing Address - Country:US
Mailing Address - Phone:530-378-0486
Mailing Address - Fax:530-378-0582
Practice Address - Street 1:2965 EAST ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3481
Practice Address - Country:US
Practice Address - Phone:530-378-0486
Practice Address - Fax:530-722-9999
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089252Medicaid
CARHM53957FMedicaid
CA553957OtherMEDICARE ID-TYPE UNSPECIFIED
CARHM53957FMedicaid