MEDICARE: DAVID ALFONSO HERNANDEZ B.A, A.A

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	103K00000X	Behavior Analyst	D8328365	CA

General Provider Information

NPI Number	:	1841568250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALFONSO HERNANDEZ B.A, A.A

Provider Business Mailing Address
First Line	:	2159 MONTE DIABLO AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95203-1226
Country	:	US
Telephone Number	:	209-938-7941
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 WATT AVE
Second Line	:	SUITE 120
City	:	SACRAMENTO
State	:	CA
Zip	:	95864
Country	:	US
Telephone Number	:	916-448-2050
Fax Number	:

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

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	02/19/2026

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