Provider Demographics
NPI:1881789840
Name:BANICO, MARIA ANNA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANNA
Last Name:BANICO
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 1:1600 E. HILL STREET
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3682
Mailing Address - Country:US
Mailing Address - Phone:562-981-4004
Mailing Address - Fax:562-427-4634
Practice Address - Street 1:1820 W. LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-780-5690
Practice Address - Fax:714-780-5696
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A752220Medicaid
CAG95442Medicare UPIN