Provider Demographics
NPI:1548802192
Name:HERNANDEZ PEREZ, DOLORES ALICIA II (RADT1)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:ALICIA
Last Name:HERNANDEZ PEREZ
Suffix:II
Gender:F
Credentials:RADT1
Other - Prefix:MRS
Other - First Name:DOLORES
Other - Middle Name:ALICIA
Other - Last Name:HERENANDEZ PEREZ
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 N JOHNSON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1651
Mailing Address - Country:US
Mailing Address - Phone:619-442-0722
Mailing Address - Fax:
Practice Address - Street 1:2049 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-4221
Practice Address - Country:US
Practice Address - Phone:619-465-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty