Provider Demographics
NPI:1225450299
Name:HERNANDEZ, MICHELLE ADRIANA (BS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ADRIANA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ADRIANA
Other - Last Name:ZEPEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:385 CALLE DE ALEGRA STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3423
Mailing Address - Country:US
Mailing Address - Phone:575-526-1105
Mailing Address - Fax:575-524-4266
Practice Address - Street 1:826 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9317
Practice Address - Country:US
Practice Address - Phone:575-201-5135
Practice Address - Fax:575-449-4052
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid