Provider Demographics
NPI:1649601568
Name:HERNANDEZ, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
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 1:17800 WOODRUFF AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7080
Mailing Address - Country:US
Mailing Address - Phone:562-866-8956
Mailing Address - Fax:562-866-4158
Practice Address - Street 1:17800 WOODRUFF AVE STE F
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7080
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:562-866-4158
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF88028106H00000X
CA88028101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist