Healthcare Provider Details

I. General information

NPI: 1245151737
Provider Name (Legal Business Name): JUSTINE MARIE PINO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 PEORIA ST
AURORA CO
80010-1517
US

IV. Provider business mailing address

2181 S TRENTON WAY
DENVER CO
80231-5393
US

V. Phone/Fax

Practice location:
  • Phone: 303-762-6554
  • Fax:
Mailing address:
  • Phone: 360-630-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1710283
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: