Healthcare Provider Details

I. General information

NPI: 1538982392
Provider Name (Legal Business Name): MIRIAM HERNANDEZ GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S FREMONT AVE BLDG A10
ALHAMBRA CA
91803-8800
US

IV. Provider business mailing address

116 N MOORE AVE APT A
MONTEREY PARK CA
91754-1586
US

V. Phone/Fax

Practice location:
  • Phone: 626-349-3838
  • Fax: 855-838-9042
Mailing address:
  • Phone: 323-557-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: