Basic Information
| Provider Information | |||||||||
| NPI: | 1144308453 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN-CONCEPCION | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8836 N 23RD AVE STE B1 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850214175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029449810 | ||||||||
| FaxNumber: | 6029441547 | ||||||||
| Practice Location | |||||||||
| Address1: | 8836 N 23RD AVE STE B1 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850214175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029449810 | ||||||||
| FaxNumber: | 6029441547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 33305 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 899247 | 05 | AZ | MEDICAID |