Healthcare Provider Details

I. General information

NPI: 1760312946
Provider Name (Legal Business Name): NOE HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87225 CHURCH ST
THERMAL CA
92274-8901
US

IV. Provider business mailing address

83640 COXCOMB DR
COACHELLA CA
92236-6813
US

V. Phone/Fax

Practice location:
  • Phone: 760-848-1816
  • Fax:
Mailing address:
  • Phone: 760-397-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240164086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: