Healthcare Provider Details

I. General information

NPI: 1770027633
Provider Name (Legal Business Name): SARA DICKES HERNANDEZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 WINDSOR ST
SAN BERNARDINO CA
92407-3364
US

IV. Provider business mailing address

1100 HILLSIDE ST
LA HABRA CA
90631-2822
US

V. Phone/Fax

Practice location:
  • Phone: 909-366-9344
  • Fax:
Mailing address:
  • Phone: 714-360-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18660
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPSY18660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: