1588156889 NPI number — DR. MATTIE HENRY LENCINAS MD

Table of content: DR. MATTIE HENRY LENCINAS MD (NPI 1588156889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588156889 NPI number — DR. MATTIE HENRY LENCINAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENCINAS
Provider First Name:
MATTIE
Provider Middle Name:
HENRY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENRY
Provider Other First Name:
MATTIE
Provider Other Middle Name:
MELISSA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588156889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3410 E RINCON VIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAIL
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85641-9329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-581-1955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 E AJO WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85713-6204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-626-5582
Provider Business Practice Location Address Fax Number:
520-626-2819
Provider Enumeration Date:
06/01/2018

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: 207P00000X , with the licence number:  R77007 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 62164 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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