Healthcare Provider Details

I. General information

NPI: 1558857003
Provider Name (Legal Business Name): BRYAN HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRYAN HERNANDEZ DE LA TORRE MSW, ACSW

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E 7TH ST
LOS ANGELES CA
90014-2209
US

IV. Provider business mailing address

256 W HOWARD ST
PASADENA CA
91103-1528
US

V. Phone/Fax

Practice location:
  • Phone: 213-893-1960
  • Fax:
Mailing address:
  • Phone: 626-354-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number396848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: