Healthcare Provider Details

I. General information

NPI: 1164043782
Provider Name (Legal Business Name): GABRIEL HERNANDEZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

IV. Provider business mailing address

223 W COLE BLVD
CALEXICO CA
92231-9722
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-2020
  • Fax: 760-355-9521
Mailing address:
  • Phone: 607-357-2020
  • Fax: 760-355-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95009118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: