Provider Demographics
NPI:1245253368
Name:POLICARPIO-NICOLAS, MARIA LUISA CARREON (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA LUISA
Middle Name:CARREON
Last Name:POLICARPIO-NICOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA LUISA
Other - Middle Name:CARREON
Other - Last Name:NICOLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7703 FLOYD CURL
Mailing Address - Street 2:MC7977
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129003207ZC0500X
TXN4675207ZC0500X, 207ZP0102X
VA0101237531207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208860102OtherCSHCN
TX208860101Medicaid
TX8L23895Medicare PIN