MEDICARE: MAYRA ALEJANDRA HERNANDEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW84859	CA
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114215217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA ALEJANDRA HERNANDEZ LCSW

Provider Business Mailing Address
First Line	:	11303 W WASHINGTON BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6003
Country	:	US
Telephone Number	:	310-482-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	11303 W WASHINGTON BLVD STE 200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6003
Country	:	US
Telephone Number	:	310-482-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2011
Last Update Date	:	05/13/2026

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