Healthcare Provider Details

I. General information

NPI: 1235181199
Provider Name (Legal Business Name): GLORIA ISABEL GERSTNER DPM MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 LANG AVE NE SUITE 110
ALBUQUERQUE NM
87109-4474
US

IV. Provider business mailing address

4801 LANG AVE NE SUITE 110
ALBUQUERQUE NM
87109-4474
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-9700
  • Fax: 505-892-1210
Mailing address:
  • Phone: 505-892-9700
  • Fax: 505-892-1210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1378
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number307
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: