Healthcare Provider Details

I. General information

NPI: 1902990393
Provider Name (Legal Business Name): IVAN G PINON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 46304TH PMG CEDAR ENDOCRINOLOGY
ALBUQUERQUE NM
87106-4917
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-563-6400
  • Fax: 505-563-6409
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-923-5354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number94356
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: