Healthcare Provider Details

I. General information

NPI: 1093629933
Provider Name (Legal Business Name): GABRIEL ATLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 CENTRAL AVE NW
ALBUQUERQUE NM
87105-1890
US

IV. Provider business mailing address

1301 CERRO VISTA RD SW
ALBUQUERQUE NM
87105-2925
US

V. Phone/Fax

Practice location:
  • Phone: 505-206-0288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: