Healthcare Provider Details

I. General information

NPI: 1689149643
Provider Name (Legal Business Name): CANDACE LENORE HERNANDEZ M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28100 BOUQUET CANYON ROAD SUITE 218
SANTA CLARITA CA
91350
US

IV. Provider business mailing address

PO BOX 220836
NEWHALL CA
91322-0836
US

V. Phone/Fax

Practice location:
  • Phone: 909-210-3282
  • Fax:
Mailing address:
  • Phone: 909-210-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT118283
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: