Provider Demographics
NPI:1033412978
Name:HERNANDEZ, JULISA ANAHI (MS)
Entity Type:Individual
Prefix:MS
First Name:JULISA
Middle Name:ANAHI
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42230 LAKE HUGHES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE HUGHES
Mailing Address - State:CA
Mailing Address - Zip Code:93532-1012
Mailing Address - Country:US
Mailing Address - Phone:661-297-1578
Mailing Address - Fax:661-296-3595
Practice Address - Street 1:42230 LAKE HUGHES RD
Practice Address - Street 2:
Practice Address - City:LAKE HUGHES
Practice Address - State:CA
Practice Address - Zip Code:93532-1012
Practice Address - Country:US
Practice Address - Phone:661-297-1578
Practice Address - Fax:661-296-3595
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health