Provider Demographics
NPI:1740772243
Name:HERNANDEZ, GUADALUPE CECILIA
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:CECILIA
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 1:10083 N ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2025
Mailing Address - Country:US
Mailing Address - Phone:530-701-6911
Mailing Address - Fax:
Practice Address - Street 1:10083 N ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2025
Practice Address - Country:US
Practice Address - Phone:530-701-6911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician