Basic Information
| Provider Information | |||||||||
| NPI: | 1275959579 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | GRECIA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | LPT. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 W CLINTON AVE BLDG W | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937054206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592647521 | ||||||||
| FaxNumber: | 5598600168 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 W CLINTON AVE BLDG W | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937054206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592647521 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2014 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT37178 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.