Healthcare Provider Details

I. General information

NPI: 1992568034
Provider Name (Legal Business Name): MICHAEL ANGELO HERNANDEZ LMSW, ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 EUCLID AVE STE 351
SAN DIEGO CA
92114-2223
US

IV. Provider business mailing address

404 EUCLID AVE STE 351
SAN DIEGO CA
92114-2223
US

V. Phone/Fax

Practice location:
  • Phone: 833-503-5910
  • Fax: 619-205-6323
Mailing address:
  • Phone: 833-503-5910
  • Fax: 619-205-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number109616
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: