Healthcare Provider Details

I. General information

NPI: 1255457867
Provider Name (Legal Business Name): ALICIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13800 HEACOCK ST STE C220
MORENO VALLEY CA
92553-3363
US

IV. Provider business mailing address

879 W 190TH ST STE 300
GARDENA CA
90248-4223
US

V. Phone/Fax

Practice location:
  • Phone: 951-653-1800
  • Fax:
Mailing address:
  • Phone: 310-323-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 40307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: