Provider Demographics
NPI:1366486144
Name:NICA, ROMANITA DANIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMANITA
Middle Name:DANIELA
Last Name:NICA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:3122 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-6610
Practice Address - Country:US
Practice Address - Phone:928-445-7632
Practice Address - Fax:928-445-9283
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2018-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ34997207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116187Medicaid
AZ116187Medicaid
AZ110149Medicare PIN
AZ133094Medicare PIN