Basic Information
| Provider Information | |||||||||
| NPI: | 1275851164 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | GILBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 N STATE ST | ||||||||
| Address2: | P.O. BOX 830 | ||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925432960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517791335 | ||||||||
| FaxNumber: | 9517913353 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 N STATE ST | ||||||||
| Address2: | |||||||||
| City: | HEMET | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925432960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517913350 | ||||||||
| FaxNumber: | 9517013353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2010 | ||||||||
| LastUpdateDate: | 05/17/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | RS5335 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | RS5335 | 01 | CA | CAL. ASSOCIATION OF ALCOHOL AND DRUG COUNSELORS | OTHER |