Healthcare Provider Details

I. General information

NPI: 1548460967
Provider Name (Legal Business Name): ROBERTO HERNANDEZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

IV. Provider business mailing address

759 S VAN NESS AVE
SAN FRANCISCO CA
94110-1908
US

V. Phone/Fax

Practice location:
  • Phone: 415-642-4550
  • Fax: 415-695-6963
Mailing address:
  • Phone: 415-642-4550
  • Fax: 415-695-6963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: