Healthcare Provider Details

I. General information

NPI: 1619862877
Provider Name (Legal Business Name): DAVID AUSTIN DILLON REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N RAILROAD AVE
ESPANOLA NM
87532-3147
US

IV. Provider business mailing address

51 CALLE CASCABELA
SANTA FE NM
87508-5903
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-6694
  • Fax:
Mailing address:
  • Phone: 336-449-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number54744
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number54744
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: