Healthcare Provider Details

I. General information

NPI: 1427971175
Provider Name (Legal Business Name): DANIELLE GACHUPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 OAK LANE
JEMEZ PUEBLO NM
87024
US

IV. Provider business mailing address

6300 RIVERSIDE PLAZA LN NW STE 100
ALBUQUERQUE NM
87120-1908
US

V. Phone/Fax

Practice location:
  • Phone: 505-630-8286
  • Fax:
Mailing address:
  • Phone: 336-510-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1-15-19611
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: