Provider Demographics
NPI:1255439485
Name:NOCERA, ZANDRA S (MD)
Entity type:Individual
Prefix:DR
First Name:ZANDRA
Middle Name:S
Last Name:NOCERA
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 53536
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-3536
Mailing Address - Country:US
Mailing Address - Phone:602-956-1994
Mailing Address - Fax:602-957-6250
Practice Address - Street 1:4440 N 36TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3589
Practice Address - Country:US
Practice Address - Phone:602-956-1994
Practice Address - Fax:602-957-6250
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ145872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ238429Medicaid
AZ117704OtherPTAN
AZ300046239OtherRAILROAD MEDICARE
AZD37383Medicare UPIN
AZZ860578753Medicare PIN
AZZ165717Medicare PIN