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NPI Code Detail

MEDICARE: PIMA MEDICAL INSTITUTE

MEDICARE: PIMA MEDICAL INSTITUTE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist921NM

General Provider Information

NPI Number : 1720491210
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIMA MEDICAL INSTITUTE
Provider Business Mailing Address
First Line : 4400 CUTLER AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-3935
Country : US
Telephone Number : 505-881-1234
Fax Number :
Provider Business Practice Location Address
First Line : 4400 CUTLER AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-3935
Country : US
Telephone Number : 505-881-1234
Fax Number :
Authorized Official
Title or Position : DENTAL HYGIENE PROGRAM DIRECTOR
Name : MRS. MELISSA PLESE
Credential : RDH, MS
Telephone Number : 505-881-1234
Provider Enumeration Date : 06/03/2014
Last Update Date : 06/03/2014

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Directions to “PIMA MEDICAL INSTITUTE ” Practice Location

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