Provider Demographics
NPI:1700372778
Name:HERNANDEZ, MARA JENNIFER (MS)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:JENNIFER
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 MARTIN LUTHER KING JR WAY APT 4
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2113
Mailing Address - Country:US
Mailing Address - Phone:925-408-1178
Mailing Address - Fax:
Practice Address - Street 1:3700 CALIFORNIA STREET
Practice Address - Street 2:ROOM 4360, 4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1618
Practice Address - Country:US
Practice Address - Phone:415-600-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001009170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS