Basic Information
Provider Information | |||||||||
NPI: | 1003298423 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAENZ | ||||||||
FirstName: | GABRIEL | ||||||||
MiddleName: | LUZ | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSN, APRN, PMHNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2902 TRADITIONS DR | ||||||||
Address2: |   | ||||||||
City: | KILLEEN | ||||||||
State: | TX | ||||||||
PostalCode: | 765496117 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2814358532 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | BDAACH/549TH HC USAG HUMPHREYS, BLDG. #3030 | ||||||||
Address2: | UNIT #15245 | ||||||||
City: | APO | ||||||||
State: | AP | ||||||||
PostalCode: | 96271 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3157372635 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/22/2015 | ||||||||
LastUpdateDate: | 11/10/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/09/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 783012 | TX | N |   | Nursing Service Providers | Registered Nurse |   | 283Q00000X | AP129633 | TX | Y |   | Hospitals | Psychiatric Hospital |   |
No ID Information.