Provider Demographics
NPI:1720202211
Name:ONA, ENRIQUE STANLEY MARTINEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:STANLEY MARTINEZ
Last Name:ONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5987
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:1050 GAIL GARDNER WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1630
Practice Address - Country:US
Practice Address - Phone:928-717-5232
Practice Address - Fax:928-717-5238
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099588007OtherMEDICARE WPS
NE30024OtherBLUE CROSS BLUE SHIELD OF NEBRASKA
NE10025691800Medicaid