Provider Demographics
NPI:1831286269
Name:HERNANDEZ, PAULINE Y
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:Y
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 1:2064 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4833
Mailing Address - Country:US
Mailing Address - Phone:916-393-7884
Mailing Address - Fax:
Practice Address - Street 1:5415 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2105
Practice Address - Country:US
Practice Address - Phone:916-429-7797
Practice Address - Fax:916-429-7943
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)