Healthcare Provider Details

I. General information

NPI: 1235348012
Provider Name (Legal Business Name): JOSE R HERNANDEZ ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 WOODMAN AVE
ARLETA CA
91331-6401
US

IV. Provider business mailing address

8902 WOODMAN AVE
ARLETA CA
91331-6401
US

V. Phone/Fax

Practice location:
  • Phone: 818-830-7033
  • Fax:
Mailing address:
  • Phone: 818-830-7033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW10975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: