Healthcare Provider Details

I. General information

NPI: 1053241208
Provider Name (Legal Business Name): CARLOS MAURICIO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 VENTURA BLVD STE 200
ENCINO CA
91436-1722
US

IV. Provider business mailing address

13561 MOORPARK ST APT 211
SHERMAN OAKS CA
91423-3858
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-9980
  • Fax:
Mailing address:
  • Phone: 818-470-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: