Basic Information
| Provider Information | |||||||||
| NPI: | 1801253018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6147 SUTTER AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956082738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169717640 | ||||||||
| FaxNumber: | 9169717714 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 E. CARSON ST. | ||||||||
| Address2: | |||||||||
| City: | COLUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304580520 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2016 | ||||||||
| LastUpdateDate: | 11/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.