Provider Demographics
NPI:1134879703
Name:CANTU, GABRIELLE DANIELLE
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:DANIELLE
Last Name:CANTU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:DANIELLE
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 N WARPATH ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9400
Mailing Address - Country:US
Mailing Address - Phone:575-241-7685
Mailing Address - Fax:
Practice Address - Street 1:2 N WARPATH ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9400
Practice Address - Country:US
Practice Address - Phone:575-241-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician