Provider Demographics
NPI:1710507702
Name:HERNANDEZ, ROSA MARIA (BEHAVIOR ASSISTANT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BEHAVIOR ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 KAISER AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5875
Mailing Address - Country:US
Mailing Address - Phone:909-201-4545
Mailing Address - Fax:
Practice Address - Street 1:9395 KAISER AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5875
Practice Address - Country:US
Practice Address - Phone:909-201-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other