Healthcare Provider Details

I. General information

NPI: 1225442486
Provider Name (Legal Business Name): MRS. KRISTA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E FESLER ST
SANTA MARIA CA
93454-4404
US

IV. Provider business mailing address

103 SUNSET DR
LOMPOC CA
93437-5413
US

V. Phone/Fax

Practice location:
  • Phone: 805-922-6597
  • Fax:
Mailing address:
  • Phone: 862-755-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: