Provider Demographics
NPI:1275142093
Name:HERNANDEZ, DEBORAH MARIE
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22245 MAVIS ST
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5628
Mailing Address - Country:US
Mailing Address - Phone:951-892-9574
Mailing Address - Fax:
Practice Address - Street 1:3576 ARLINGTON AVE STE 106
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3907
Practice Address - Country:US
Practice Address - Phone:951-788-5905
Practice Address - Fax:951-788-5903
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker