NPI 1104471085

Kellen J Pino, MSLATATCCES

Practitioner Sports Medicine (Preventive Medicine) Physician Albuquerque, NM

Practice location

Address: 12200 Lomas Blvd NE, Albuquerque, NM 87112-5804
Phone: (505) 559-2200
Mailing address: 4500 Shadow Ave NW, Albuquerque, NM 87114-5063

Registered specialties

Sports Medicine (Preventive Medicine) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 2083S0010X Licence 424 (NM)

Other Preventive Medicine providers in New Mexico →

Registry record

NPI: 1104471085
Entity type: Individual
Sex (as registered): Male
NPI issued: 7 Aug 2019
Record last updated: 7 Aug 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.