Provider Demographics
NPI:1003406398
Name:HERNANDEZ, CHRISTIAN (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 S GRAND OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4112
Mailing Address - Country:US
Mailing Address - Phone:323-420-1785
Mailing Address - Fax:
Practice Address - Street 1:52 S GRAND OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4112
Practice Address - Country:US
Practice Address - Phone:323-420-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist