Basic Information
| Provider Information | |||||||||
| NPI: | 1043850944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | VIVIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9068 BARTEE AVE | ||||||||
| Address2: | |||||||||
| City: | ARLETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913314806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186443602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 566 S BRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913404002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188980223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2020 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 122036 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 81687 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 125925 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.