Provider Demographics
NPI:1700236924
Name:HERNANDEZ SUTTON, OSCAR RAFAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:RAFAEL
Last Name:HERNANDEZ SUTTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13980 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5121
Mailing Address - Country:US
Mailing Address - Phone:831-225-0213
Mailing Address - Fax:408-445-0875
Practice Address - Street 1:13980 BLOSSOM HILL RD
Practice Address - Street 2:SUITE D
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5121
Practice Address - Country:US
Practice Address - Phone:831-225-0213
Practice Address - Fax:408-445-0875
Is Sole Proprietor?:No
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28375103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical