Healthcare Provider Details

I. General information

NPI: 1154534782
Provider Name (Legal Business Name): MARITA BARLAHAN BIAG, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/07/2013
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 Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARITA BARLAHAN-BIAG
Title or Position: OWNER
Credential: M.D.
Phone: 916-638-0600