Healthcare Provider Details

I. General information

NPI: 1407678097
Provider Name (Legal Business Name): ARELY HERNANDEZ LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BARBARA LOOP SE
RIO RANCHO NM
87124-1039
US

IV. Provider business mailing address

7923 TAFWOOD RD NW
ALBUQUERQUE NM
87120-4089
US

V. Phone/Fax

Practice location:
  • Phone: 505-589-5959
  • Fax:
Mailing address:
  • Phone: 505-639-2831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8557
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: