Provider Demographics
NPI:1831658673
Name:HERNANDEZ, KATHERYN ALICIA
Entity Type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ALICIA
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 1:2101 W CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1936
Mailing Address - Country:US
Mailing Address - Phone:714-417-1573
Mailing Address - Fax:
Practice Address - Street 1:13001 SEAL BEACH BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2754
Practice Address - Country:US
Practice Address - Phone:949-551-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist