Provider Demographics
NPI:1730418088
Name:ITUAH, MARTINS ORIAREHU MONDAY
Entity type:Individual
Prefix:DR
First Name:MARTINS
Middle Name:ORIAREHU MONDAY
Last Name:ITUAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 TRAIL BLAZER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6983
Mailing Address - Country:US
Mailing Address - Phone:915-859-6447
Mailing Address - Fax:
Practice Address - Street 1:10850 N LOOP DR
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927-4411
Practice Address - Country:US
Practice Address - Phone:915-860-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist