Healthcare Provider Details

I. General information

NPI: 1235099110
Provider Name (Legal Business Name): ROSA ERICA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23990 EUCALYPTUS AVE
MORENO VALLEY CA
92553-5504
US

IV. Provider business mailing address

213 E ALESSANDRO BVLD #6A 311
RIVERSIDE CA
92508
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4689
  • Fax:
Mailing address:
  • Phone: 323-868-5754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT153491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: