MEDICARE: CHRISTINA HERNANDEZ LCSW

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	1041C0700X	Clinical Social Worker	109902	CA

General Provider Information

NPI Number	:	1720861370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA HERNANDEZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 56517
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92517-1417
Country	:	US
Telephone Number	:	951-481-6009
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 CANYON SPRINGS PKWY STE I
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-0951
Country	:	US
Telephone Number	:	951-481-6009
Fax Number	:

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

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/12/2024

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