Healthcare Provider Details

I. General information

NPI: 1427680883
Provider Name (Legal Business Name): MS. JANETTE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD STE 110
HAWAIIAN GARDENS CA
90716-2604
US

IV. Provider business mailing address

100 W AVENIDA DE LA MERCED
MONTEBELLO CA
90640-2617
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax: 562-246-5704
Mailing address:
  • Phone: 323-449-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: