Basic Information
| Provider Information | |||||||||
| NPI: | 1801240452 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 CALLE DE ALEGRA | ||||||||
| Address2: | BLDG. A | ||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880053423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755261105 | ||||||||
| FaxNumber: | 5755244266 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 E LISA DR | ||||||||
| Address2: | |||||||||
| City: | CHAPARRAL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880817809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758240820 | ||||||||
| FaxNumber: | 5758241021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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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 | 104100000X | M-09504 | NM | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.