Healthcare Provider Details

I. General information

NPI: 1528099280
Provider Name (Legal Business Name): DOLORES TIONGCO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 N 7TH ST
GRAND JUNCTION CO
81501-8117
US

IV. Provider business mailing address

2345 N 7TH ST
GRAND JUNCTION CO
81501-8117
US

V. Phone/Fax

Practice location:
  • Phone: 970-256-0066
  • Fax: 970-256-7723
Mailing address:
  • Phone: 970-256-0066
  • Fax: 970-256-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number38987
License Number StateCO

VIII. Authorized Official

Name: DR. DOLORES TIONGCO
Title or Position: OWNER
Credential: MD
Phone: 970-256-0066