Healthcare Provider Details

I. General information

NPI: 1134065857
Provider Name (Legal Business Name): GIOVANNI HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4695 MACARTHUR CT STE NEWPORT
NEWPORT BEACH CA
92660-1882
US

IV. Provider business mailing address

811 W 15TH ST
SANTA ANA CA
92706-3672
US

V. Phone/Fax

Practice location:
  • Phone: 888-880-9270
  • Fax:
Mailing address:
  • Phone: 657-256-2193
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: