Healthcare Provider Details

I. General information

NPI: 1548990419
Provider Name (Legal Business Name): ALMA DELIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 E CESAR E CHAVEZ AVE
LOS ANGELES CA
90022-1209
US

IV. Provider business mailing address

900 CORPORATE CTR DR STE 350
MONTEREY PARK CA
91754-7620
US

V. Phone/Fax

Practice location:
  • Phone: 323-881-3799
  • Fax:
Mailing address:
  • Phone: 323-526-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number110109
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: