MEDICARE: DR. CENTINA 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	TL-26	AZ

General Provider Information

NPI Number	:	1679058317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CENTINA HERNANDEZ PSY.D.

Provider Business Mailing Address
First Line	:	32 E SERENE AVE UNIT 203
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-3774
Country	:	US
Telephone Number	:	702-954-4674
Fax Number	:

Provider Business Practice Location Address
First Line	:	4270 S DECATUR BLVD STE A10A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6801
Country	:	US
Telephone Number	:	702-912-5559
Fax Number	:

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

Provider Enumeration Date	:	09/28/2018
Last Update Date	:	09/28/2018

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