Provider Demographics
NPI:1689791600
Name:HERNANDEZ, ANGIE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:ELIZABETH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:ELIZABETH
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:214 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-2849
Mailing Address - Country:US
Mailing Address - Phone:707-438-0492
Mailing Address - Fax:707-816-0291
Practice Address - Street 1:214 VALENCIA DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-2849
Practice Address - Country:US
Practice Address - Phone:707-438-0492
Practice Address - Fax:707-816-0291
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XOtherMENTAL HEALTH COUNSELOR