1851459242 NPI number — MS. DEBORAH MARTINEZ CUNNINGHAM RDH

Table of content: MS. DEBORAH MARTINEZ CUNNINGHAM RDH (NPI 1851459242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851459242 NPI number — MS. DEBORAH MARTINEZ CUNNINGHAM RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
DEBORAH
Provider Middle Name:
MARTINEZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851459242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 PRINTERS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80910-3190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-228-6635
Provider Business Mailing Address Fax Number:
719-228-6612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 HYBROOK ROAD -SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIVIDE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-687-4460
Provider Business Practice Location Address Fax Number:
719-687-4457
Provider Enumeration Date:
12/05/2006

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: 124Q00000X , with the licence number:  903812 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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