Provider Demographics
NPI:1790880854
Name:COLOMER DE SACA, NIDIA MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDIA
Middle Name:MARIA
Last Name:COLOMER DE SACA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4252
Mailing Address - Country:US
Mailing Address - Phone:909-465-2077
Mailing Address - Fax:909-627-8106
Practice Address - Street 1:5343 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4252
Practice Address - Country:US
Practice Address - Phone:909-465-2077
Practice Address - Fax:909-627-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG6069702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G606970Medicaid
CA00G606970Medicare ID - Type Unspecified
CAE69571Medicare UPIN