1205922366 NPI number — MRS. REBECCA MARIE MARTINEZ CPC

Table of content: MRS. REBECCA MARIE MARTINEZ CPC (NPI 1205922366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205922366 NPI number — MRS. REBECCA MARIE MARTINEZ CPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
REBECCA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPC
Provider Gender Code:
F

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:
1205922366
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:
25135 F HWY 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESCALERO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-464-4441
Provider Business Mailing Address Fax Number:
505-464-4422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 ABALONE LOOP
Provider Second Line Business Practice Location Address:
MESCALERO INDIAN HOSPITAL
Provider Business Practice Location Address City Name:
MESCALERO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-464-4441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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: 246YC3301X , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com