Healthcare Provider Details

I. General information

NPI: 1609626829
Provider Name (Legal Business Name): DOLORES ANN PYLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LA JARA ST
BLOOMFIELD NM
87413-6626
US

IV. Provider business mailing address

325 N BERGIN LN
BLOOMFIELD NM
87413-6729
US

V. Phone/Fax

Practice location:
  • Phone: 505-634-3883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number20240107
License Number StateNM

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: