Healthcare Provider Details

I. General information

NPI: 1427378504
Provider Name (Legal Business Name): HEATHER LYNN HERNANDEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 BUSINESS CENTER DR STE 10A
SAN BERNARDINO CA
92408-3438
US

IV. Provider business mailing address

1881 BUSINESS CENTER DR STE 10A
SAN BERNARDINO CA
92408-3438
US

V. Phone/Fax

Practice location:
  • Phone: 909-890-2381
  • Fax: 909-890-0580
Mailing address:
  • Phone: 909-890-2381
  • Fax: 909-890-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: