1720202211 NPI number — DR. ENRIQUE STANLEY MARTINEZ ONA M.D.

Table of content: DR. ENRIQUE STANLEY MARTINEZ ONA M.D. (NPI 1720202211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720202211 NPI number — DR. ENRIQUE STANLEY MARTINEZ ONA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ONA
Provider First Name:
ENRIQUE
Provider Middle Name:
STANLEY MARTINEZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720202211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86304-0880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-759-5987
Provider Business Mailing Address Fax Number:
928-458-2039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13991 W GRAND AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SURPRISE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85374-3065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-455-7800
Provider Business Practice Location Address Fax Number:
234-557-8306
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  5017 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30024 . This is a "BLUE CROSS BLUE SHIELD OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025691800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 099588007 . This is a "MEDICARE WPS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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