Healthcare Provider Details

I. General information

NPI: 1093829210
Provider Name (Legal Business Name): PINON PERINATAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 RUTLEDGE RD NE
ALBUQUERQUE NM
87109-5566
US

IV. Provider business mailing address

3741 RUTLEDGE RD NE
ALBUQUERQUE NM
87109-5566
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number92-255
License Number StateNM

VIII. Authorized Official

Name: DR. TIMOTHY J HURLEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-798-9300