Healthcare Provider Details

I. General information

NPI: 1205507076
Provider Name (Legal Business Name): ALEXIS CHRISTINE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD
PASADENA CA
91107-1448
US

IV. Provider business mailing address

19738 E GOLDEN BOUGH DR
COVINA CA
91724-3814
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: