Provider Demographics
NPI:1861056285
Name:GACHUPIN, STUART (CPSW)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:GACHUPIN
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SHEEP SPRINGS
Mailing Address - Street 2:
Mailing Address - City:JEMEZ PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87024-0279
Mailing Address - Country:US
Mailing Address - Phone:575-834-7258
Mailing Address - Fax:575-834-9507
Practice Address - Street 1:110 SHEEP SPRINGS
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87024-0279
Practice Address - Country:US
Practice Address - Phone:575-834-7258
Practice Address - Fax:575-834-9507
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM581174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist