Healthcare Provider Details

I. General information

NPI: 1629575279
Provider Name (Legal Business Name): MARIA CRISTINA HERNANDEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 06/22/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 ORCHARD RD
HOLTVILLE CA
92250-9403
US

IV. Provider business mailing address

1807 ORCHARD RD
HOLTVILLE CA
92250-9403
US

V. Phone/Fax

Practice location:
  • Phone: 760-840-7435
  • Fax:
Mailing address:
  • Phone: 760-840-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: