Provider Demographics
NPI:1134546526
Name:HERNANDEZ, GEORGINA GUADALUPE I
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:GUADALUPE
Last Name:HERNANDEZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GEORGINA
Other - Middle Name:GUADALUPE
Other - Last Name:HERNANDEZ
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10555 MONTGOMERY BLVD NE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3857
Mailing Address - Country:US
Mailing Address - Phone:505-503-7946
Mailing Address - Fax:
Practice Address - Street 1:10555 MONTGOMERY BLVD NE BLDG 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3857
Practice Address - Country:US
Practice Address - Phone:505-503-7946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator