Healthcare Provider Details

I. General information

NPI: 1104769140
Provider Name (Legal Business Name): SIMON HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5385 HOLLISTER AVE BLDG 2/3
GOLETA CA
93111-2389
US

IV. Provider business mailing address

5385 HOLLISTER AVE BLDG 2/3
GOLETA CA
93111-2389
US

V. Phone/Fax

Practice location:
  • Phone: 805-683-8060
  • Fax: 805-683-8061
Mailing address:
  • Phone: 805-683-8060
  • Fax: 805-683-8061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: