Healthcare Provider Details

I. General information

NPI: 1598879652
Provider Name (Legal Business Name): PINON FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST BLDG C-2
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

2300 E 30TH ST BLDG C-2
FARMINGTON NM
87401-8990
US

V. Phone/Fax

Practice location:
  • Phone: 505-324-1000
  • Fax: 505-324-1199
Mailing address:
  • Phone: 505-324-1000
  • Fax: 505-324-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ADANA MOHLER
Title or Position: CLINIC MANAGER
Credential:
Phone: 505-324-1000