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General NPI Number Information
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NPI Number | 1699355768
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Entity Type | Individual
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Provider Name | MAIRA M HERNANDEZ LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 5151 N PALM AVE STE 200
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City | FRESNO
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State | CA
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Zip | 93704-2221
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Country | US
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Telephone | 559-241-8085
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Fax | 559-702-6101
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Provider Business Mailing Address
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Address Line | 1187 N WILLOW AVE # 103-880
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City | CLOVIS
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State | CA
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Zip | 93611-4411
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Country | US
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Telephone | 559-241-8085
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Fax | 559-702-6101
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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 | 99813
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License Number State | CA
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