Provider Demographics
NPI:1104848290
Name:UNGOS, ERWINA (DO)
Entity Type:Individual
Prefix:DR
First Name:ERWINA
Middle Name:
Last Name:UNGOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-776-5976
Mailing Address - Fax:
Practice Address - Street 1:NORTHERN ARIZONA VA HCS
Practice Address - Street 2:500 N. HWY 89
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3690207P00000X
CA20A6523207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A65230Medicaid
CA020A65230Medicaid
AZZ78734Medicare ID - Type Unspecified
CA0020A6523Medicare ID - Type Unspecified