Organization
MARTIN ANCONA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN ANCONA (PH.D)
(214) 662-1791
Entity
Organization
Contact information
Practice address
224 ANTHONY DR, ANTHONY, NM 88021-9366
(214) 662-1791
Mailing address
224 ANTHONY DR, ANTHONY, NM 88021-9366
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
04/29/2019
Last updated
10/09/2019
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