Healthcare Provider Details

I. General information

NPI: 1164331096
Provider Name (Legal Business Name): REBECCA E HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E WEBSTER ST
COLUSA CA
95932-2951
US

IV. Provider business mailing address

251 E WEBSTER ST
COLUSA CA
95932-2951
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-0868
  • Fax: 530-458-0250
Mailing address:
  • Phone: 530-458-0868
  • Fax: 530-458-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: