Healthcare Provider Details

I. General information

NPI: 1821082546
Provider Name (Legal Business Name): DOLORES D TIONGCO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 HOOVER DR
GRAND JUNCTION CO
81504-5700
US

IV. Provider business mailing address

541 HOOVER DR
GRAND JUNCTION CO
81504-5700
US

V. Phone/Fax

Practice location:
  • Phone: 970-256-0066
  • Fax:
Mailing address:
  • Phone: 970-256-0066
  • Fax: 970-712-5420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number38987
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: