Kellen J Pino, MS, LAT, ATC, CES

Primary specialty

Sports Medicine (Preventive Medicine) PhysicianTaxonomy code 2083S0010X

License

424 Issued in NM

Practice address

12200 Lomas Blvd NE
Albuquerque, NM 87112-5804

Phone

(505) 559-2200

NPI assigned

Aug 7, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Unm Hospital

  • General Acute Care Hospital
  • Albuquerque, NM
  • NPI 1689747552
  NPD (past)
• Unm Medical Group Inc

  dba Center for Development & Disability

  • Developmental Disabilities Clinic/Center
  • Albuquerque, NM
  • NPI 1851614432
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565136000000",
    "number": "1104471085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 SHADOW AVE NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145063",
            "telephone_number": "505-681-0748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 LOMAS BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871125804",
            "telephone_number": "505-559-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINO",
        "first_name": "KELLEN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "MS, LAT, ATC, CES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-07",
        "last_updated": "2019-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083S0010X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Sports Medicine",
            "state": "NM",
            "license": "424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaryn Pino, CSFA
• Albertyn Pino, CPSW
• Curtis Michael Pino, DDS
• Danielle Nicole Pino, RN
• Kateri Pino
• Klassie C Pino
• Krista Pino
• Melissa Rose Pino, CNP
• Onnica Pino
• Stephanie Pino

• Sports Medicine (Preventive Medicine) Physician in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Sports Medicine (Preventive Medicine) Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.