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Organization
PINON HEALTHCARE, LLC
Active
Organization
PINON HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIKILYN TYSON (OWNER)
(505) 860-5180
Entity
Organization
Contact information
Practice address
904 E 20TH ST STE B, FARMINGTON, NM 87401-4281
(505) 787-2680
(505) 787-2668
Mailing address
PO BOX 166, FARMINGTON, NM 87499-0166
(505) 787-2680
(505) 787-2668
Taxonomy
Speciality
Code
Description
License number
State
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000000000
IN PROGRESS
—
Enumeration date
08/27/2019
Last updated
08/27/2019
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