Provider Demographics
NPI:1801373360
Name:NICA, ROXANA GABRIELA
Entity Type:Individual
Prefix:
First Name:ROXANA
Middle Name:GABRIELA
Last Name:NICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 BUCK OWENS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-4935
Mailing Address - Country:US
Mailing Address - Phone:661-633-2125
Mailing Address - Fax:
Practice Address - Street 1:4200 BUCK OWENS BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-4935
Practice Address - Country:US
Practice Address - Phone:661-633-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492995225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant