| Martin Ancona Llc | |
|
224 Anthony Dr Anthony NM 88021-9366 | |
| (214) 662-1791 | |
| Not Available |
| Full Name | Martin Ancona Llc |
|---|---|
| Speciality | Psychologist |
| Location | 224 Anthony Dr, Anthony, New Mexico |
| Authorized Official Name and Position | Martin Ancona (PH.D) |
| Authorized Official Contact | 2146621791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Martin Ancona Llc 224 Anthony Dr Anthony NM 88021-9366 Ph: () - | Martin Ancona Llc 224 Anthony Dr Anthony NM 88021-9366 Ph: (214) 662-1791 |
| NPI Number | 1437713062 |
|---|---|
| Provider Enumeration Date | 04/29/2019 |
| Last Update Date | 10/09/2019 |
| Medicare PECOS PAC ID | 5496087744 |
|---|---|
| Medicare Enrollment ID | O20191106000410 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437713062 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Martin Nicholas Ancona |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1003065749 PECOS PAC ID: 4789813700 Enrollment ID: I20140214000421 |
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