Provider Demographics
NPI:1558037994
Name:HERNANDEZ, BREANNA NICHOLE
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:NICHOLE
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 1:1973 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1251
Mailing Address - Country:US
Mailing Address - Phone:818-471-3184
Mailing Address - Fax:
Practice Address - Street 1:1973 19TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1251
Practice Address - Country:US
Practice Address - Phone:818-471-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician