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General NPI Number Information
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NPI Number | 1164992350
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Entity Type | Individual
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Provider Name | SUSANA HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 236 GEORGIA ST STE 102
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City | VALLEJO
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State | CA
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Zip | 94590-5962
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Country | US
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Telephone | 888-544-5553
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Fax | 888-722-7972
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Provider Business Mailing Address
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Address Line | 527 PORTER ST
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City | VALLEJO
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State | CA
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Zip | 94590-7257
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Country | US
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Telephone | 707-631-0535
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB452282
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License Number State | CA
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