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General NPI Number Information
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NPI Number | 1699030072
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Entity Type | Individual
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Provider Name | MS. KATHY ANN HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 720 E GILBERT ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92415-3248
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Country | US
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Telephone | 909-501-0981
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Fax |
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Provider Business Mailing Address
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Address Line | 1364 N PAMPAS AVE
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City | RIALTO
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State | CA
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Zip | 92376-3647
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Country | US
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Telephone | 909-440-3192
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 99607
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 99607
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License Number State | CA
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