Healthcare Provider Details

I. General information

NPI: 1386451714
Provider Name (Legal Business Name): CLAUDIA GUADALUPE MATIAS-HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8836 S VERMONT AVE
LOS ANGELES CA
90044-4832
US

IV. Provider business mailing address

6309 ALBANY ST
HUNTINGTON PARK CA
90255-3509
US

V. Phone/Fax

Practice location:
  • Phone: 323-593-5300
  • Fax:
Mailing address:
  • Phone: 323-571-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number135198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: