Provider Demographics
NPI:1588156889
Name:LENCINAS, MATTIE HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:MATTIE
Middle Name:HENRY
Last Name:LENCINAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MATTIE
Other - Middle Name:MELISSA
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3410 E RINCON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-9329
Mailing Address - Country:US
Mailing Address - Phone:928-581-1955
Mailing Address - Fax:
Practice Address - Street 1:2800 E AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-6204
Practice Address - Country:US
Practice Address - Phone:520-626-5582
Practice Address - Fax:520-626-2819
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR77007207P00000X
AZ62164207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine