Healthcare Provider Details

I. General information

NPI: 1073104527
Provider Name (Legal Business Name): HOPE J GAONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 09/16/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5004 ALBERTA LN NW
ALBUQUERQUE NM
87120-2404
US

IV. Provider business mailing address

5004 ALBERTA LN NW
ALBUQUERQUE NM
87120-2404
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-1946
  • Fax: 505-554-1389
Mailing address:
  • Phone: 505-977-1946
  • Fax: 505-554-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7000
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: