Provider Demographics
NPI:1528099280
Name:DOLORES TIONGCO MD PC
Entity type:Organization
Organization Name:DOLORES TIONGCO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:TIONGCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-256-0066
Mailing Address - Street 1:2345 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8117
Mailing Address - Country:US
Mailing Address - Phone:970-256-0066
Mailing Address - Fax:970-256-7723
Practice Address - Street 1:2345 N 7TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8117
Practice Address - Country:US
Practice Address - Phone:970-256-0066
Practice Address - Fax:970-256-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38987103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12073822Medicaid
CO805907Medicare PIN