Provider Demographics
NPI:1619517240
Name:HERNANDEZ GAONA, ALBA
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:
Last Name:HERNANDEZ GAONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 MCCRAY ST APT B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1269
Mailing Address - Country:US
Mailing Address - Phone:702-934-4986
Mailing Address - Fax:
Practice Address - Street 1:416 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3332
Practice Address - Country:US
Practice Address - Phone:559-791-0104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2020-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20407183500000X
CA81881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist