Healthcare Provider Details

I. General information

NPI: 1194368100
Provider Name (Legal Business Name): GABRIELA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9890 COUNTY FARM RD STE 3
RIVERSIDE CA
92503-3678
US

IV. Provider business mailing address

9890 COUNTY FARM RD STE 3
RIVERSIDE CA
92503-3678
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-8320
  • Fax:
Mailing address:
  • Phone: 951-509-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number270754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: