Healthcare Provider Details

I. General information

NPI: 1932688363
Provider Name (Legal Business Name): REGINA MARIE HERNANDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 W FOOTHILL BLVD # 140A
UPLAND CA
91786-8702
US

IV. Provider business mailing address

PO BOX 602060
SAN DIEGO CA
92160-2060
US

V. Phone/Fax

Practice location:
  • Phone: 323-543-2941
  • Fax:
Mailing address:
  • Phone: 877-840-6956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number95530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: