Provider Demographics
NPI:1871268193
Name:HERNANDEZ, ELIZABETH LEONELA (BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEONELA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 W 190TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4370
Mailing Address - Country:US
Mailing Address - Phone:714-785-3196
Mailing Address - Fax:
Practice Address - Street 1:1411 W 190TH ST STE 110
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4370
Practice Address - Country:US
Practice Address - Phone:714-785-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
CA1-20-43350103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst