Healthcare Provider Details

I. General information

NPI: 1275851164
Provider Name (Legal Business Name): MR. GILBERT HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N STATE ST
HEMET CA
92543-2960
US

IV. Provider business mailing address

650 N STATE ST P.O. BOX 830
HEMET CA
92543-2960
US

V. Phone/Fax

Practice location:
  • Phone: 951-791-3350
  • Fax: 951-701-3353
Mailing address:
  • Phone: 951-779-1335
  • Fax: 951-791-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRS5335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: