Healthcare Provider Details

I. General information

NPI: 1184152183
Provider Name (Legal Business Name): VANESSA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 CARNEGIE DR STE 270
SAN BERNARDINO CA
92408-3592
US

IV. Provider business mailing address

735 CARNEGIE DR STE 270
SAN BERNARDINO CA
92408-3592
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-1078
  • Fax: 909-658-1049
Mailing address:
  • Phone: 909-793-1078
  • Fax: 909-658-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: