Provider Demographics
NPI:1053976860
Name:ORELL-HERNANDEZ, ABAGAIL LYNN
Entity type:Individual
Prefix:
First Name:ABAGAIL
Middle Name:LYNN
Last Name:ORELL-HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABAGAIL
Other - Middle Name:
Other - Last Name:ORELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 CONNECTICUT ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-3223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3951 CAMINO DE LA PLZ STE 109
Practice Address - Street 2:
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-5909
Practice Address - Country:US
Practice Address - Phone:619-340-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant