Provider Demographics
NPI:1679188668
Name:ARISTONDO-MARTINEZ, OMA NAOMI
Entity Type:Individual
Prefix:
First Name:OMA
Middle Name:NAOMI
Last Name:ARISTONDO-MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-1759
Mailing Address - Country:US
Mailing Address - Phone:304-283-7025
Mailing Address - Fax:
Practice Address - Street 1:404 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-1759
Practice Address - Country:US
Practice Address - Phone:304-283-7025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVW00601313502Medicaid