Provider Demographics
NPI:1275710279
Name:HERNANDEZ, VERONICA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:CHAVEZ HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:525 CABRILLO PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5017
Mailing Address - Country:US
Mailing Address - Phone:714-953-4455
Mailing Address - Fax:714-542-2793
Practice Address - Street 1:525 CABRILLO PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5017
Practice Address - Country:US
Practice Address - Phone:714-953-4455
Practice Address - Fax:714-542-2793
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49233106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist