Provider Demographics
NPI:1386924769
Name:DINO-PEDS MANAGEMENT GROUP
Entity type:Organization
Organization Name:DINO-PEDS MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-242-7060
Mailing Address - Street 1:1190 BOOKCLIFF AVE
Mailing Address - Street 2:#104
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8133
Mailing Address - Country:US
Mailing Address - Phone:970-242-7060
Mailing Address - Fax:970-242-6198
Practice Address - Street 1:1190 BOOKCLIFF AVE
Practice Address - Street 2:#104
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8133
Practice Address - Country:US
Practice Address - Phone:970-242-7060
Practice Address - Fax:970-242-6198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP990086363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty