Healthcare Provider Details

I. General information

NPI: 1386158152
Provider Name (Legal Business Name): HERNANDEZ ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 N ALAMEDA BLVD
LAS CRUCES NM
88005-2130
US

IV. Provider business mailing address

619 N ALAMEDA BLVD
LAS CRUCES NM
88005-2130
US

V. Phone/Fax

Practice location:
  • Phone: 575-405-5446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0193101
License Number StateNM

VIII. Authorized Official

Name: SARAHI HERNANDEZ
Title or Position: OWNER
Credential: LMFT
Phone: 575-202-0965