Provider Demographics
NPI:1891882668
Name:ASENCIO, ALIDA (MD)
Entity Type:Individual
Prefix:
First Name:ALIDA
Middle Name:
Last Name:ASENCIO
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:PO BOX HH
Mailing Address - Street 2:HWY 77/75
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68067-0767
Mailing Address - Country:US
Mailing Address - Phone:402-878-2231
Mailing Address - Fax:402-878-2237
Practice Address - Street 1:HWY 77/75
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68067-0767
Practice Address - Country:US
Practice Address - Phone:402-878-2231
Practice Address - Fax:402-878-2237
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5174208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01063Medicaid
350063Medicare Oscar/Certification