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General NPI Number Information
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NPI Number | 1457586984
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Entity Type | Individual
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Provider Name | LISA MARIE HERNANDEZ MA
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Gender | Female
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 2730 WILSHIRE BLVD STE 650
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City | SANTA MONICA
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State | CA
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Zip | 90403-4746
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Country | US
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Telephone | 424-253-8824
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Fax | 424-389-7572
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Provider Business Mailing Address
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Address Line | 3836 OVERLAND AVE UNIT 5
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City | CULVER CITY
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State | CA
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Zip | 90232-3367
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Country | US
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Telephone | 818-257-2405
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Fax | 424-389-7572
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 79612
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT79612
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License Number State | CA
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