Healthcare Provider Details

I. General information

NPI: 1376015164
Provider Name (Legal Business Name): TRESCINA MICHELLE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E COOLEY DR
COLTON CA
92324-3905
US

IV. Provider business mailing address

22887 BRENTWOOD ST
GRAND TERRACE CA
92313-4908
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: