Healthcare Provider Details

I. General information

NPI: 1821733999
Provider Name (Legal Business Name): IAN CARLO BIACO CADIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W I ST # B
LOS BANOS CA
93635-3479
US

IV. Provider business mailing address

1287 ABERDEEN AVE
WINNIPEG MANITOBA
R2X 1T7
CA

V. Phone/Fax

Practice location:
  • Phone: 209-826-2222
  • Fax: 209-826-2599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA201310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: