Provider Demographics
NPI:1043100647
Name:HERNANDEZ, BRYAN GEORGE
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:GEORGE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 FALL ST
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-5698
Mailing Address - Country:US
Mailing Address - Phone:775-376-0108
Mailing Address - Fax:
Practice Address - Street 1:150 RIDGE ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1986
Practice Address - Country:US
Practice Address - Phone:775-376-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health