Healthcare Provider Details

I. General information

NPI: 1083425870
Provider Name (Legal Business Name): GABRIEL U NAZARENO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 NARROW LANE RD
MONTGOMERY AL
36116-2953
US

IV. Provider business mailing address

9743 IVY GREEN DR
MONTGOMERY AL
36117-5152
US

V. Phone/Fax

Practice location:
  • Phone: 334-284-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL NAZARENO
Title or Position: OWNER
Credential: MD
Phone: 334-201-8168