Provider Demographics
NPI:1164893038
Name:HERNANDEZ, RAYMOND (MS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12968 FREDERICK ST
Mailing Address - Street 2:STE A
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5229
Mailing Address - Country:US
Mailing Address - Phone:714-834-9690
Mailing Address - Fax:
Practice Address - Street 1:400 S FARRELL DR STE B210
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7933
Practice Address - Country:US
Practice Address - Phone:760-620-5554
Practice Address - Fax:760-620-5559
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 88975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist