Healthcare Provider Details

I. General information

NPI: 1821716101
Provider Name (Legal Business Name): MARISSA YESENIA MOISA HERNANDEZ ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44505 90TH ST W
LANCASTER CA
93536-7705
US

IV. Provider business mailing address

44205 HONEYBEE LN
LANCASTER CA
93536-7129
US

V. Phone/Fax

Practice location:
  • Phone: 661-992-9424
  • Fax: 714-276-2604
Mailing address:
  • Phone: 661-992-9424
  • Fax: 714-276-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number140687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: