Healthcare Provider Details

I. General information

NPI: 1194527770
Provider Name (Legal Business Name): JUDITH RAQUEL HERNANDEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL UNIT 106B
SANTA FE NM
87505-1833
US

IV. Provider business mailing address

1211 8TH ST STE C
ALAMOGORDO NM
88310-5808
US

V. Phone/Fax

Practice location:
  • Phone: 866-273-2451
  • Fax:
Mailing address:
  • Phone: 866-273-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: