Healthcare Provider Details

I. General information

NPI: 1295780799
Provider Name (Legal Business Name): HOPE MEDICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 E BASELINE RD SUITE 114
MESA AZ
85206-4613
US

IV. Provider business mailing address

PO BOX 682
GILBERT AZ
85299-0682
US

V. Phone/Fax

Practice location:
  • Phone: 480-633-0294
  • Fax: 480-633-0604
Mailing address:
  • Phone: 480-633-0294
  • Fax: 480-633-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23489
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3461
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN082346
License Number StateAZ

VIII. Authorized Official

Name: DR. PEDRO J MARTINEZ
Title or Position: PRESIDENT CEO
Credential: MD
Phone: 480-633-0294