Provider Demographics
NPI:1689096190
Name:PINON PERINATAL
Entity Type:Organization
Organization Name:PINON PERINATAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEG
Authorized Official - Middle Name:M
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-263-8808
Mailing Address - Street 1:3741 RUTLEDGE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-798-9300
Mailing Address - Fax:505-798-0808
Practice Address - Street 1:3741 RUTLEDGE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-798-9300
Practice Address - Fax:505-798-0808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINON PERINATAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD6491Medicaid
NMD6491Medicaid
341420505Medicare PIN