Healthcare Provider Details

I. General information

NPI: 1124097837
Provider Name (Legal Business Name): MARITA Q. BARLAHAN-BIAG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 GOLD EXPRESS DR SUITE D
GOLD RIVER CA
95670-4400
US

IV. Provider business mailing address

11200 GOLD EXPRESS DR SUITE D
GOLD RIVER CA
95670-4400
US

V. Phone/Fax

Practice location:
  • Phone: 916-638-0600
  • Fax: 916-638-0602
Mailing address:
  • Phone: 916-638-0600
  • Fax: 916-638-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA67369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: