Provider Demographics
NPI:1790320224
Name:HERNANDEZ, GEMA (MS)
Entity Type:Individual
Prefix:MRS
First Name:GEMA
Middle Name:
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 1:21185 NW EVERGREEN PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7127
Mailing Address - Country:US
Mailing Address - Phone:503-531-3322
Mailing Address - Fax:
Practice Address - Street 1:21185 NW EVERGREEN PKWY STE 105
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-7127
Practice Address - Country:US
Practice Address - Phone:503-531-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PRTPC-III-11-48-7057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional