Healthcare Provider Details

I. General information

NPI: 1174076723
Provider Name (Legal Business Name): LUS ORALIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 07/30/2023
Certification Date: 07/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N ORCHID DR
HOBBS NM
88240-3159
US

IV. Provider business mailing address

1911 N ORCHID DR
HOBBS NM
88240-3159
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-7048
  • Fax:
Mailing address:
  • Phone: 575-636-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12142
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: