Provider Demographics
NPI:1083749337
Name:HERNANDEZ, LIZBETH GUADALUPE (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:LIZBETH
Middle Name:GUADALUPE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:LIZBETH
Other - Middle Name:GUADALUPE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:813 W WHITTIER BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4759
Mailing Address - Country:US
Mailing Address - Phone:626-991-9876
Mailing Address - Fax:
Practice Address - Street 1:813 W WHITTIER BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4759
Practice Address - Country:US
Practice Address - Phone:626-991-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83508106H00000X
CAIMF67162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist