Provider Demographics
NPI:1427372382
Name:HERNANDEZ, VICTORIA LAVONNE (MA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LAVONNE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 UNION PLAZA CT STE 102
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-5655
Mailing Address - Country:US
Mailing Address - Phone:760-743-9457
Mailing Address - Fax:
Practice Address - Street 1:1310 UNION PLAZA CT STE 102
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5655
Practice Address - Country:US
Practice Address - Phone:760-439-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC 3875101YP2500X
CALPC3875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional