Healthcare Provider Details

I. General information

NPI: 1851948970
Provider Name (Legal Business Name): JULISSA JERRICKA HERNANDEZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41399 CHAPEL WAY
FREMONT CA
94538-4298
US

IV. Provider business mailing address

28368 ROCHELLE AVE
HAYWARD CA
94544-5450
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-3537
  • Fax:
Mailing address:
  • Phone: 562-313-3470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number230142313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: