Provider Demographics
NPI:1093576142
Name:HERNANDEZ, GABRIELA MONIQUE (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:MONIQUE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W RAMONA RD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3440
Mailing Address - Country:US
Mailing Address - Phone:626-673-2377
Mailing Address - Fax:
Practice Address - Street 1:2212 EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3000
Practice Address - Country:US
Practice Address - Phone:877-312-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT298366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist