Healthcare Provider Details

I. General information

NPI: 1003298423
Provider Name (Legal Business Name): GABRIEL LUZ SAENZ MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 11/10/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BDAACH/549TH HC USAG HUMPHREYS, BLDG. #3030 UNIT #15245
APO AP
96271
US

IV. Provider business mailing address

2902 TRADITIONS DR
KILLEEN TX
76549-6117
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-2635
  • Fax:
Mailing address:
  • Phone: 281-435-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number783012
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberAP129633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: