Healthcare Provider Details

I. General information

NPI: 1720940612
Provider Name (Legal Business Name): GABRIELA ENDRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1896 E BABBIT LN
SAN LUIS AZ
85336-7820
US

IV. Provider business mailing address

PO BOX 617
SOMERTON AZ
85350-0617
US

V. Phone/Fax

Practice location:
  • Phone: 928-722-6116
  • Fax: 928-550-5466
Mailing address:
  • Phone: 928-662-0406
  • Fax: 928-662-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number340110
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: