Provider Demographics
NPI:1639589260
Name:HERNANDEZ, JUDI (CADC-II)
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N SAN GABRIEL AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2058
Mailing Address - Country:US
Mailing Address - Phone:626-343-3665
Mailing Address - Fax:
Practice Address - Street 1:330 E LIVE OAK AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5617
Practice Address - Country:US
Practice Address - Phone:626-254-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA8910213101YA0400X
CAA07570315101YA0400X, 225400000X
225400000X
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)