Healthcare Provider Details

I. General information

NPI: 1033836341
Provider Name (Legal Business Name): VANESSA HERNANDEZ MADERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 N EL MOLINO AVE
PASADENA CA
91101-1805
US

IV. Provider business mailing address

725 DATE ST
MONTEBELLO CA
90640-6132
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-2770
  • Fax:
Mailing address:
  • Phone: 323-239-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: