Healthcare Provider Details

I. General information

NPI: 1972209211
Provider Name (Legal Business Name): RACHELLE PINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 HERRERA DR
SANTA FE NM
87507-2684
US

IV. Provider business mailing address

PO BOX 4744
SANTA FE NM
87502-4744
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3233
  • Fax:
Mailing address:
  • Phone: 505-204-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71711
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: