Provider Demographics
NPI:1841470135
Name:GABRIEL A HERNANDEZ
Entity type:Organization
Organization Name:GABRIEL A HERNANDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-521-3388
Mailing Address - Street 1:3885 FOOTHILLS RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4672
Mailing Address - Country:US
Mailing Address - Phone:505-521-3388
Mailing Address - Fax:505-521-4023
Practice Address - Street 1:3885 FOOTHILLS RD STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4672
Practice Address - Country:US
Practice Address - Phone:505-521-3388
Practice Address - Fax:505-521-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty