Provider Demographics
NPI:1457664807
Name:HERNANDEZ, MARTHA ESTELA
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ESTELA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:ESTELA
Other - Last Name:HERNANDEZ DE CASTANEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1144 CAMELOT WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-4017
Mailing Address - Country:US
Mailing Address - Phone:805-278-1320
Mailing Address - Fax:
Practice Address - Street 1:1144 CAMELOT WAY
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4017
Practice Address - Country:US
Practice Address - Phone:805-278-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist