Healthcare Provider Details

I. General information

NPI: 1518245430
Provider Name (Legal Business Name): MARIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 12TH ST STE A
MARINA CA
93933-6003
US

IV. Provider business mailing address

299 12TH ST STE A
MARINA CA
93933-6003
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-7652
  • Fax:
Mailing address:
  • Phone: 831-647-7652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW128529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: