MEDICARE: CHARLENE HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	103K00000X	Behavior Analyst
2	171M00000X	Case Manager/Care Coordinator
3	225400000X	Rehabilitation Practitioner	CA

General Provider Information

NPI Number	:	1508246794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE HERNANDEZ

Provider Business Mailing Address
First Line	:	8270 MARLETTE ST
Second Line	:
City	:	MOKELUMNE HILL
State	:	CA
Zip	:	95245-9468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	590 TOYANZA DRIVE
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9713
Country	:	US
Telephone Number	:	951-543-0031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	03/19/2026

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Directions to “ CHARLENE HERNANDEZ ” Practice Location

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