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NPI Code Detail

MEDICARE: JOHANNA TERESA HERNANDEZ MATEO

MEDICARE: JOHANNA TERESA HERNANDEZ MATEO
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1629833686
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHANNA TERESA HERNANDEZ MATEO
Provider Business Mailing Address
First Line : 2901 S SEPULVEDA BLVD APT 158
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-3941
Country : US
Telephone Number : 323-695-6134
Fax Number :
Provider Business Practice Location Address
First Line : 11287 WASHINGTON BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4615
Country : US
Telephone Number : 323-695-6134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2024
Last Update Date : 04/30/2026

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Directions to “ JOHANNA TERESA HERNANDEZ MATEO ” Practice Location

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