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General NPI Number Information
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NPI Number | 1588223150
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Entity Type | Organization
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Legal Business Name | PINON SLEEP CENTER, LLC
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 904 E 20TH ST STE C
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City | FARMINGTON
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State | NM
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Zip | 87401-4281
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Country | US
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Telephone | 505-860-5180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 166
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City | FARMINGTON
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State | NM
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Zip | 87499-0166
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Country | US
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Telephone | 505-860-5180
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIKILYN TYSON
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Credential |
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Telephone | 505-860-5180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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