Provider Demographics
NPI:1710933254
Name:UY-UYAN, NIZA PENA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIZA
Middle Name:PENA
Last Name:UY-UYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIZA
Other - Middle Name:
Other - Last Name:UY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11401 SOUTH BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-651-3182
Mailing Address - Fax:916-654-3186
Practice Address - Street 1:11401 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2015
Practice Address - Country:US
Practice Address - Phone:562-863-7011
Practice Address - Fax:562-864-4560
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAH065141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90458Medicare UPIN
00A651410Medicare ID - Type Unspecified