Provider Demographics
NPI:1194927376
Name:CORICA, ALBERTO G (MD)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:G
Last Name:CORICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6369 E TANQUE VERDE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3833
Mailing Address - Country:US
Mailing Address - Phone:520-333-4468
Mailing Address - Fax:833-314-0378
Practice Address - Street 1:6369 E TANQUE VERDE RD STE 160
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3833
Practice Address - Country:US
Practice Address - Phone:520-333-4468
Practice Address - Fax:833-314-0378
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0773208800000X
IDM-11543208800000X
PR11563-I282N00000X
AZ55657208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
1386250835OtherNPI