MEDICARE: DEBORAH MARIE HERNANDEZ

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	172V00000X	Community Health Worker
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275142093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH MARIE HERNANDEZ

Provider Business Mailing Address
First Line	:	22245 MAVIS ST
Second Line	:
City	:	GRAND TERRACE
State	:	CA
Zip	:	92313-5628
Country	:	US
Telephone Number	:	951-892-9574
Fax Number	:

Provider Business Practice Location Address
First Line	:	3576 ARLINGTON AVE STE 106
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3907
Country	:	US
Telephone Number	:	951-788-5905
Fax Number	:	951-788-5903

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

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	01/09/2024

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