Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 31971 | AZ |
NPI | 1114929783 |
---|---|
Provider Name | Dr. Marcelyn Ann Lepique |
First Address | Cortez, CO 81321-2231 |
Second Address | Cortez, CO 81321-2231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 07/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201171314 | AZ FND MED CARE (01) | AZ |
4801210 | CIGNA (01) | AZ |
AZ0756920 | BC/BS AZ (01) | AZ |
E70243 | (02) | AZ |