MEDICARE: REBECA HERNANDEZ ASW

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	ASW135290	CA

General Provider Information

NPI Number	:	1407789134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECA HERNANDEZ ASW

Provider Business Mailing Address
First Line	:	242 MANHATTAN ST
Second Line	:
City	:	MANTECA
State	:	CA
Zip	:	95337-2095
Country	:	US
Telephone Number	:	619-549-4004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 ARCH AIRPORT RD STE 50
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95206-4945
Country	:	US
Telephone Number	:	209-636-0003
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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