Healthcare Provider Details

I. General information

NPI: 1689096190
Provider Name (Legal Business Name): PINON PERINATAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 RUTLEDGE NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

3741 RUTLEDGE NE
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-798-9300
  • Fax: 505-798-0808
Mailing address:
  • Phone: 505-798-9300
  • Fax: 505-798-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name: MS. PEG M HURLEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 505-263-8808