Provider Demographics
NPI:1285818450
Name:HERNANDEZ, LUPE
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:
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 1:10261 TRADEMARK ST STE C
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5805
Mailing Address - Country:US
Mailing Address - Phone:909-317-8499
Mailing Address - Fax:909-614-8578
Practice Address - Street 1:10261 TRADEMARK ST STE C
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5805
Practice Address - Country:US
Practice Address - Phone:093-178-4999
Practice Address - Fax:909-614-8578
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician