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General NPI Number Information
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NPI Number | 1821020363
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Entity Type | Organization
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Legal Business Name | PINON HILLS EAR NOSE AND THROAT ASSOCIATES PA
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 2300 E 30TH ST BLDG D-102
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City | FARMINGTON
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State | NM
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Zip | 87401-8991
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Country | US
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Telephone | 505-327-4429
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Fax | 505-327-4420
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Provider Business Mailing Address
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Address Line | 2300 E 30TH ST BLDG D-102
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City | FARMINGTON
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State | NM
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Zip | 87401-8990
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Country | US
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Telephone | 505-327-4429
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. HAZEL ILENE JACKSON
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Credential |
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Telephone | 505-327-4429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number |
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License Number State |
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