Provider Demographics
NPI:1780839936
Name:HERNANDEZ, LUIS (BA- SOCIOLOGY)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:BA- SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47825 OASIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-6950
Mailing Address - Country:US
Mailing Address - Phone:760-863-8145
Mailing Address - Fax:
Practice Address - Street 1:3050 CHICAGO AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-3418
Practice Address - Country:US
Practice Address - Phone:951-686-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health