Basic Information
| Provider Information | |||||||||
| NPI: | 1194280693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | IRMA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15638 TRACY ST | ||||||||
| Address2: | |||||||||
| City: | SAN LORENZO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945801621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104155072 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7200 BANCROFT AVE STE 267 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946052403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107350864 | ||||||||
| FaxNumber: | 5107461196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2019 | ||||||||
| LastUpdateDate: | 02/08/2019 | ||||||||
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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 | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.