DR. SAMUEL PONCE NANDIN M.D. NPI 1124180054

NPI Information

NPI: 1124180054
Provider Name: DR. SAMUEL PONCE NANDIN, M.D.
Classification: General Practice - 208D00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
13851 W LA MAR BLVD
STE C
GOODYEAR, AZ
ZIP 85338
Phone: (623) 925-2622
Get Directions

DR. Samuel Ponce Nandin, M.D. is a general practice in Goodyear, AZ. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DR. Samuel Ponce Nandin, M.D. NPI is 1124180054. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

13851 W LA MAR BLVD
STE C
GOODYEAR, AZ
ZIP 85338-389
Phone: (623) 925-2622
Fax: (623) 925-9260

The NPI 1124180054 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/15/2006 and was last updated on 6/21/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		AZ15582	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2Z1748	OTHER	ARIZONA	HEALTH NET
2	562491245	OTHER	ARIZONA	AZ. FOUNDATION FOR MEDICA
3	AZ0766630	OTHER	ARIZONA	BCBS OF AZ
4	273607001	OTHER	ARIZONA	AHCCCS
5	562491245	OTHER	ARIZONA	HUMANA
6	562491245	OTHER	ARIZONA	UNITEDHEALTH CARE
7	5008111	OTHER	ARIZONA	AETNA PROVIDER NO.
8	562491245	OTHER	ARIZONA	BEECHSTREET NETWORK
9	562491245	OTHER	ARIZONA	SCF OF ARIZONA
10	106223600	OTHER	ARIZONA	OWCP
11	562491245	OTHER	ARIZONA	LIFE WISE HEALTHPLAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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