Healthcare Provider Details

I. General information

NPI: 1093278426
Provider Name (Legal Business Name): DANIEL NICOARA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

IV. Provider business mailing address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-6305
  • Fax: 509-575-3398
Mailing address:
  • Phone: 509-469-6305
  • Fax: 509-575-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberOP61408148
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: