Basic Information
| Provider Information | |||||||||
| NPI: | 1144617853 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | JOSSIE | ||||||||
| MiddleName: | MARLYN | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5576 ASH ST | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925094835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092827731 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12968 FREDERICK ST | ||||||||
| Address2: | STE D | ||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925535229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512427738 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2015 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF84991 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.