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General NPI Number Information
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NPI Number | 1891976205
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Entity Type | Individual
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Provider Name | KIMBERLY RAE HERNANDEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 26137 LA PAZ RD STE 230
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5337
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Country | US
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Telephone | 949-591-8610
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Fax | 949-595-0296
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Provider Business Mailing Address
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Address Line | 26137 LA PAZ RD STE 230 25551 DEL PRADO P.O. BOX #830 DANA POINT, CA 92629
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5337
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Country | US
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Telephone | 949-595-8610
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Fax | 949-595-0296
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 131181
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License Number State | CA
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