Healthcare Provider Details

I. General information

NPI: 1922912609
Provider Name (Legal Business Name): ANGELICA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WOOD LN
RUIDOSO DOWNS NM
88346-5040
US

IV. Provider business mailing address

104 ASPEN DR SPC 19
CAPITAN NM
88316-5105
US

V. Phone/Fax

Practice location:
  • Phone: 575-260-1808
  • Fax:
Mailing address:
  • Phone: 316-992-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: