Provider Demographics
NPI:1730486473
Name:HERNANDEZ, WANDA
Entity Type:Individual
Prefix:
First Name:WANDA
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 1:4040 BOULDER HWY
Mailing Address - Street 2:1021
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-2508
Mailing Address - Country:US
Mailing Address - Phone:702-426-4388
Mailing Address - Fax:
Practice Address - Street 1:4040 BOULDER HWY
Practice Address - Street 2:1021
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-2508
Practice Address - Country:US
Practice Address - Phone:702-426-4388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst