Provider Demographics
NPI:1275096117
Name:HERNANDEZ, KIMBERLY ESTHER (SLP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ESTHER
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1936
Mailing Address - Country:US
Mailing Address - Phone:714-417-1506
Mailing Address - Fax:
Practice Address - Street 1:2080 N TUSTIN AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7875
Practice Address - Country:US
Practice Address - Phone:949-581-0100
Practice Address - Fax:949-709-0311
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34585235Z00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician