MEDICARE: DR. LAURA HERNANDEZ PSY.D

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY25001	CA

General Provider Information

NPI Number	:	1649302324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA HERNANDEZ PSY.D

Provider Business Mailing Address
First Line	:	5715 ALLOTT AVE
Second Line	:
City	:	VALLEY GLEN
State	:	CA
Zip	:	91401-4504
Country	:	US
Telephone Number	:	310-871-0702
Fax Number	:

Provider Business Practice Location Address
First Line	:	5777 W CENTURY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5600
Country	:	US
Telephone Number	:	310-871-0702
Fax Number	:

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	08/30/2013

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