Provider Demographics
NPI:1922385285
Name:BICERA, ELEANOR QUINIO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:QUINIO
Last Name:BICERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1223
Mailing Address - Country:US
Mailing Address - Phone:909-624-3017
Mailing Address - Fax:909-624-8068
Practice Address - Street 1:795 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1223
Practice Address - Country:US
Practice Address - Phone:909-624-3017
Practice Address - Fax:909-624-8068
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5978131Medicaid