Provider Demographics
NPI:1093300774
Name:HERNANDEZ CARRASCO, GABRIEL RYAN (OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:RYAN
Last Name:HERNANDEZ CARRASCO
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 TAYLOR RANCH RD NW STE C2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2962
Mailing Address - Country:US
Mailing Address - Phone:505-508-3497
Mailing Address - Fax:
Practice Address - Street 1:6911 TAYLOR RANCH RD NW STE C2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2962
Practice Address - Country:US
Practice Address - Phone:505-508-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT4433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist