Individual
DR. MARTIN NICHOLAS ANCONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
320 MCCOMBS RD STE C, CHAPARRAL, NM 88081-7937
(575) 882-5100
(575) 882-1151
Mailing address
785 ANTHONY DRIVE, ANTHONY, NM 88021-9747
(575) 882-5100
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY60201752
WA
103TC0700X
Clinical Psychologist
1296
NM
103TP0016X
Prescribing (Medical) Psychologist
Primary
0040C
NM
Other
Enumeration date
09/18/2008
Last updated
02/28/2017
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