Provider Demographics
NPI:1063833804
Name:HERNANDEZ, LUIS
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
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 1:3905 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1014
Mailing Address - Country:US
Mailing Address - Phone:415-337-2401
Mailing Address - Fax:415-337-2415
Practice Address - Street 1:3905 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1014
Practice Address - Country:US
Practice Address - Phone:415-337-2401
Practice Address - Fax:415-337-2415
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor