Healthcare Provider Details

I. General information

NPI: 1205745601
Provider Name (Legal Business Name): CLARISSA ANAHI HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE UNIT 116
FRESNO CA
93705-4227
US

IV. Provider business mailing address

5355 N. VALENTINE AVE BLDG 25 APT 106
FRESNO CA
93711
US

V. Phone/Fax

Practice location:
  • Phone: 559-726-3922
  • Fax:
Mailing address:
  • Phone: 559-726-3922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: