Healthcare Provider Details

I. General information

NPI: 1508779174
Provider Name (Legal Business Name): NINEL HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5924 ANAHEIM AVE NE STE B
ALBUQUERQUE NM
87113-1879
US

IV. Provider business mailing address

5924 ANAHEIM AVE NE STE B
ALBUQUERQUE NM
87113-1879
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-4618
  • Fax: 505-922-4917
Mailing address:
  • Phone: 505-881-4618
  • Fax: 505-922-4917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2025-0325
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: