Provider Demographics
NPI:1588937965
Name:HERNANDEZ-AGUIRRE, CRISTIAN JOSUE
Entity type:Individual
Prefix:MR
First Name:CRISTIAN
Middle Name:JOSUE
Last Name:HERNANDEZ-AGUIRRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:JOSUE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4151
Mailing Address - Country:US
Mailing Address - Phone:575-769-2345
Mailing Address - Fax:
Practice Address - Street 1:1111 W FIR ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-5826
Practice Address - Country:US
Practice Address - Phone:575-356-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator