MEDICARE: DOLORES D TIONGCO MD

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
1	2084P0800X	Psychiatry Physician	38987	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821082546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOLORES D TIONGCO MD

Provider Business Mailing Address
First Line	:	541 HOOVER DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5700
Country	:	US
Telephone Number	:	970-256-0066
Fax Number	:	970-712-5420

Provider Business Practice Location Address
First Line	:	541 HOOVER DR
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5700
Country	:	US
Telephone Number	:	970-256-0066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	10/09/2018

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