Healthcare Provider Details

I. General information

NPI: 1982527255
Provider Name (Legal Business Name): DALLAS CAMIRIN, SINJIN LORETTO CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BUTTERFLY ROAD
TAOS NM
87571
US

IV. Provider business mailing address

610 CRITCHER RD
TAOS NM
87571-4409
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-6977
  • Fax:
Mailing address:
  • Phone: 575-758-6977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2102
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: