Healthcare Provider Details

I. General information

NPI: 1497959332
Provider Name (Legal Business Name): NICOLAS GABRIEL BIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23861 MCBEAN PKWY STE E21
SANTA CLARITA CA
91355-4457
US

IV. Provider business mailing address

13311 GALEWOOD ST
SHERMAN OAKS CA
91423-4907
US

V. Phone/Fax

Practice location:
  • Phone: 818-600-1602
  • Fax:
Mailing address:
  • Phone: 917-348-1060
  • Fax: 909-206-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberC172433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: