Healthcare Provider Details

I. General information

NPI: 1619622024
Provider Name (Legal Business Name): CHRISTOPHER JOHN HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6235 RIVER CREST DR STE O
RIVERSIDE CA
92507-0758
US

IV. Provider business mailing address

6235 RIVER CREST DR STE O
RIVERSIDE CA
92507-0758
US

V. Phone/Fax

Practice location:
  • Phone: 866-727-8274
  • Fax:
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: