Provider Demographics
NPI:1164456208
Name:PINO, EUNICE BACA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:BACA
Last Name:PINO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:EUNICE
Other - Middle Name:BACA
Other - Last Name:PINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:6320 RIVERSIDE PLAZA LN NW
Mailing Address - Street 2:STE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1710
Mailing Address - Country:US
Mailing Address - Phone:505-843-6168
Mailing Address - Fax:505-247-9743
Practice Address - Street 1:101 HOSPITAL LOOP NE STE 105
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2100
Practice Address - Country:US
Practice Address - Phone:505-843-6168
Practice Address - Fax:505-792-1978
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM487176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70478741Medicaid
P69136Medicare UPIN
NM341327901Medicare ID - Type Unspecified