Healthcare Provider Details

I. General information

NPI: 1366354136
Provider Name (Legal Business Name): SAVANNA MARIE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S MOUNT VERNON AVE STE 90
COLTON CA
92324-3928
US

IV. Provider business mailing address

2935 E LA CADENA DR
RIVERSIDE CA
92507-2628
US

V. Phone/Fax

Practice location:
  • Phone: 909-660-0097
  • Fax:
Mailing address:
  • Phone: 909-913-2374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: