Provider Demographics
NPI:1407578446
Name:HERNANDEZ, ASHLI JAMIRA
Entity Type:Individual
Prefix:
First Name:ASHLI
Middle Name:JAMIRA
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 1:1066 JENSEN CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-6312
Mailing Address - Country:US
Mailing Address - Phone:925-597-9569
Mailing Address - Fax:
Practice Address - Street 1:1066 JENSEN CIR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-6312
Practice Address - Country:US
Practice Address - Phone:925-597-9569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician