Healthcare Provider Details

I. General information

NPI: 1326923178
Provider Name (Legal Business Name): DIONTE HARDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 EUCLID AVE NE
ALBUQUERQUE NM
87110-4008
US

IV. Provider business mailing address

5715 EUCLID AVE NE
ALBUQUERQUE NM
87110-4008
US

V. Phone/Fax

Practice location:
  • Phone: 505-804-3566
  • Fax:
Mailing address:
  • Phone: 505-804-3566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: