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NPI Code Detail

MEDICARE: GABRIEL A HERNANDEZ

MEDICARE: GABRIEL A HERNANDEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist2003-0024NM

General Provider Information

NPI Number : 1841470135
Entity Type Code : Organization
Provider Name (Legal Business Name) : GABRIEL A HERNANDEZ
Provider Business Mailing Address
First Line : 3885 FOOTHILLS RD STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-4672
Country : US
Telephone Number : 505-521-3388
Fax Number : 505-521-4023
Provider Business Practice Location Address
First Line : 3885 FOOTHILLS RD STE B
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-4672
Country : US
Telephone Number : 505-521-3388
Fax Number : 505-521-4023
Authorized Official
Title or Position : OFFICE MANAGER
Name : CYNTHIA LOPEZ
Credential :
Telephone Number : 505-521-3388
Provider Enumeration Date : 11/05/2007
Last Update Date : 11/05/2007

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Directions to “GABRIEL A HERNANDEZ ” Practice Location

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