Healthcare Provider Details

I. General information

NPI: 1912643792
Provider Name (Legal Business Name): AUTUMN HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 9TH AVE STE 208
SAN DIEGO CA
92101-7277
US

IV. Provider business mailing address

2440 STEAMBOAT SPRINGS CT
CHULA VISTA CA
91915-2223
US

V. Phone/Fax

Practice location:
  • Phone: 619-800-6060
  • Fax:
Mailing address:
  • Phone: 619-227-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: