Provider Demographics
NPI:1396005815
Name:HERNANDEZ, PATRICIA MIRANDA
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MIRANDA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MIRANDA MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18080 CRENSHAW BLVD UNIT 6733
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-6430
Mailing Address - Country:US
Mailing Address - Phone:310-961-0158
Mailing Address - Fax:
Practice Address - Street 1:2301 E 28TH ST STE 309
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-2181
Practice Address - Country:US
Practice Address - Phone:310-961-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA897581041C0700X
CAASW68873104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical