Provider Demographics
NPI:1154201515
Name:HERNANDEZ, GABRIELLA CRYSTAL (CHW)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:CRYSTAL
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SE WOODSTOCK BLVD APT 209
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-6882
Mailing Address - Country:US
Mailing Address - Phone:971-401-0169
Mailing Address - Fax:
Practice Address - Street 1:3530 SE 88TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2396
Practice Address - Country:US
Practice Address - Phone:503-772-4335
Practice Address - Fax:503-772-4337
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR114750172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker