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General NPI Number Information
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NPI Number | 1003872037
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Entity Type | Individual
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Provider Name | STEPHANIE D MARTINEZ HAWTHORNE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 06/25/2022
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Provider Practice Location Address
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Address Line | 7701 W ASPERA BLVD
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City | GLENDALE
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State | AZ
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Zip | 85308-7947
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Country | US
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Telephone | 623-248-2109
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Fax | 623-707-4893
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Provider Business Mailing Address
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Address Line | 7701 W ASPERA BLVD
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City | GLENDALE
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State | AZ
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Zip | 85308-7947
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Country | US
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Telephone | 623-248-2109
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Fax | 623-707-4893
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 29691
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License Number State | AZ
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