1922215623 NPI number — ENIS M MARTINEZ, M. D. A PROFFESSIONAL CORPORATION

Table of content: (NPI 1922215623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922215623 NPI number — ENIS M MARTINEZ, M. D. A PROFFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENIS M MARTINEZ, M. D. A PROFFESSIONAL CORPORATION
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:
1922215623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 SUNSET DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLISTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95023-5613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-637-1655
Provider Business Mailing Address Fax Number:
831-637-6894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 SUNSET DR STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLISTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95023-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-637-1655
Provider Business Practice Location Address Fax Number:
831-637-6894
Provider Enumeration Date:
05/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINEZ
Authorized Official First Name:
ENIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-637-1655

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G43931 , 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: 00G439310 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com