Provider Demographics
NPI:1124707229
Name:HERNANDEZ, GABRIELA IDALIA
Entity type:Individual
Prefix:
First Name:GABRIELA
Middle Name:IDALIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 CAMINO DE LOS ALMACIGOS
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-5257
Mailing Address - Country:US
Mailing Address - Phone:787-955-2975
Mailing Address - Fax:
Practice Address - Street 1:STATE ROAD 31, BARRIO CEIBA NORTE
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3200
Practice Address - Country:US
Practice Address - Phone:787-713-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008343183500000X
FL42301390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program