Provider Demographics
NPI:1114117496
Name:HERNANDEZ, ROBERT (BA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 EL CAJON BLVD
Mailing Address - Street 2:STE. K
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-3435
Mailing Address - Country:US
Mailing Address - Phone:619-668-6200
Mailing Address - Fax:
Practice Address - Street 1:7339 EL CAJON BLVD
Practice Address - Street 2:STE. K
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-3435
Practice Address - Country:US
Practice Address - Phone:619-668-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist