MEDICARE: MS. VIRGINIA 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	LCS19072	CA

General Provider Information

NPI Number	:	1639297997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA HERNANDEZ LCSW

Provider Business Mailing Address
First Line	:	5375 WALNUT AVE UNIT 2225
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91708-7104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5375 WALNUT AVE UNIT 2225
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91708-7104
Country	:	US
Telephone Number	:	323-823-9223
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	10/06/2012

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