Provider Demographics
NPI:1609005719
Name:HERNANDEZ, ELISANDER
Entity Type:Individual
Prefix:
First Name:ELISANDER
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5816
Mailing Address - Country:US
Mailing Address - Phone:530-534-6400
Mailing Address - Fax:530-534-6401
Practice Address - Street 1:2218 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5816
Practice Address - Country:US
Practice Address - Phone:530-534-6400
Practice Address - Fax:530-534-6401
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional