Healthcare Provider Details

I. General information

NPI: 1326684655
Provider Name (Legal Business Name): JOSE MIGUEL HERNANDEZ MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 SHERMAN CIR
VAN NUYS CA
91405-3087
US

IV. Provider business mailing address

8321 BARDWELL AVE
PANORAMA CITY CA
91402-3915
US

V. Phone/Fax

Practice location:
  • Phone: 818-909-6868
  • Fax: 818-902-9637
Mailing address:
  • Phone: 818-359-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberAPCC6473
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT110276
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT156883
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT156883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: