Provider Demographics
NPI:1881803773
Name:NICASIO, NIDA VICTORIA (MD)
Entity type:Individual
Prefix:DR
First Name:NIDA
Middle Name:VICTORIA
Last Name:NICASIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:NIDA
Other - Middle Name:NICASIO
Other - Last Name:GANCAYCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6 VENTURE
Mailing Address - Street 2:350
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3340
Mailing Address - Country:US
Mailing Address - Phone:949-753-8800
Mailing Address - Fax:949-753-8899
Practice Address - Street 1:6 VENTURE
Practice Address - Street 2:350
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3340
Practice Address - Country:US
Practice Address - Phone:949-753-8800
Practice Address - Fax:949-753-8899
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist