Healthcare Provider Details

I. General information

NPI: 1457657157
Provider Name (Legal Business Name): JUAN PABLO HERNANDEZ GUIDANCE/COUNCELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 MCNUTT RD
SUNLAND PARK NM
88063-9056
US

IV. Provider business mailing address

3130 SAVANNAH AVE
EL PASO TX
79930-4432
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-1338
  • Fax: 575-915-1819
Mailing address:
  • Phone: 915-244-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: