Organization
FIVE SANDOVAL INDIAN PUEBLOS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TONI PINO (ADMINISTRATIVE ASSISTANT-F.S.I.P IN)
(505) 867-3351
Entity
Organization
Contact information
Practice address
1043 HWY 313, BERNALILLO, NM 87004
(505) 867-3351
(505) 867-3514
Mailing address
1043 HWY 313, BERNALILLO, NM 87004
(505) 867-3351
(505) 867-3514
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
01728213006
NM
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96386002
—
NM
Enumeration date
05/03/2007
Last updated
04/23/2009
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