Provider Demographics
NPI:1174000194
Name:HERNANDEZ, JUAN DUENES
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:DUENES
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 1:9360 N NAME UNO STE 130
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3535
Mailing Address - Country:US
Mailing Address - Phone:408-843-9350
Mailing Address - Fax:
Practice Address - Street 1:424 NOICE DR APT 88E
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-2870
Practice Address - Country:US
Practice Address - Phone:831-206-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst