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General NPI Number Information
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NPI Number | 1932465846
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Entity Type | Individual
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Provider Name | RAUL LUIS HERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 431 W COMPTON BLVD
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City | COMPTON
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State | CA
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Zip | 90220-3008
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Country | US
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Telephone | 424-785-5689
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 EAST PINE AVENUE
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City | EL SEGUNDO
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State | LOS ANGELES
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Zip | 90245
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Country | UM
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Telephone | 310-706-1273
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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 | RI-H1204021303
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License Number State | CA
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