1699127183 NPI number — MARIO MARTINEZ

Table of content: (NPI 1699127183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699127183 NPI number — MARIO MARTINEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIO MARTINEZ
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1699127183
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE 8 AVE 6
Provider Second Line Business Mailing Address:
APT 2
Provider Business Mailing Address City Name:
AGUA PRIETA
Provider Business Mailing Address State Name:
SONORA
Provider Business Mailing Address Postal Code:
84200
Provider Business Mailing Address Country Code:
MX
Provider Business Mailing Address Telephone Number:
520-505-7563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 8 AVE 6
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
AGUA PRIETA
Provider Business Practice Location Address State Name:
SONORA
Provider Business Practice Location Address Postal Code:
84200
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
520-505-7563
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
MARIO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-505-7563

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5234317 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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