Provider Demographics
NPI:1891156642
Name:HERNANDEZ, ESTELLA (6680-R)
Entity Type:Individual
Prefix:
First Name:ESTELLA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:6680-R
Other - Prefix:
Other - First Name:ESTELLA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:6680-R
Mailing Address - Street 1:10511 MILLS AVENUE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604
Mailing Address - Country:US
Mailing Address - Phone:562-944-7953
Mailing Address - Fax:562-946-7494
Practice Address - Street 1:10511 MILLS AVENUE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604
Practice Address - Country:US
Practice Address - Phone:562-944-7953
Practice Address - Fax:562-946-7494
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6680-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6680-ROtherCAADE