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General NPI Number Information
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NPI Number | 1578347993
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Entity Type | Individual
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Provider Name | VIKTOR HERNANDEZ-MORA
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Gender | Male
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 550 FESLER ST STE G-1
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City | EL CAJON
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State | CA
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Zip | 92020-1959
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Country | US
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Telephone | 619-588-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 415 KNOLLCREST DR STE 101
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City | REDDING
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State | CA
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Zip | 96002-0181
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Country | US
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Telephone | 530-392-4399
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 016538
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License Number State | CA
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