Healthcare Provider Details

I. General information

NPI: 1629721881
Provider Name (Legal Business Name): MYRA ALEJANDRA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MYRA ALEJANDRA RAMOS

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 S PALM AVE
HEMET CA
92543-4808
US

IV. Provider business mailing address

5005 CANYON CREST DR
RIVERSIDE CA
92507-7721
US

V. Phone/Fax

Practice location:
  • Phone: 951-247-6542
  • Fax:
Mailing address:
  • Phone: 747-224-2090
  • 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: