1619068137 NPI number — EVELYN NA-ADJIELEY TETTEH-MARTEY MD

Table of content: EVELYN NA-ADJIELEY TETTEH-MARTEY MD (NPI 1619068137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619068137 NPI number — EVELYN NA-ADJIELEY TETTEH-MARTEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETTEH-MARTEY
Provider First Name:
EVELYN
Provider Middle Name:
NA-ADJIELEY
Provider Name Prefix Text:
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:
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:
1619068137
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:
1001 S STATE ST
Provider Second Line Business Mailing Address:
APPLE MEDICAL CENTER AND URGENT CARE INC
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92543-7635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-925-2525
Provider Business Mailing Address Fax Number:
951-925-6834

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28401 BRADLEY RD
Provider Second Line Business Practice Location Address:
#A
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-679-7022
Provider Business Practice Location Address Fax Number:
951-672-9541
Provider Enumeration Date:
09/28/2006

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: 207R00000X , with the licence number:  A81873 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00A818730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com