Healthcare Provider Details

I. General information

NPI: 1801740592
Provider Name (Legal Business Name): SAMANTHA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 MCCRAY ST
RIVERSIDE CA
92506-2928
US

IV. Provider business mailing address

1916 N MOUNTAIN VIEW AVE
SAN BERNARDINO CA
92405-4132
US

V. Phone/Fax

Practice location:
  • Phone: 951-289-4069
  • Fax:
Mailing address:
  • Phone: 626-239-5045
  • Fax:

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: