Provider Demographics
NPI:1033193958
Name:ANCA, MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:ANCA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MONTE BRISAS APTO 5206
Mailing Address - Street 2:C/JOSE FIDALGO DIAZ
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-604-4231
Mailing Address - Fax:
Practice Address - Street 1:201 AVE DE DIEGO
Practice Address - Street 2:STE 40
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5828
Practice Address - Country:US
Practice Address - Phone:787-782-6664
Practice Address - Fax:787-774-3766
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0056835Medicare ID - Type Unspecified
V02628Medicare UPIN