Provider Demographics
NPI:1962847202
Name:HERNANDEZ, LAURA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4777
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93744-4777
Mailing Address - Country:US
Mailing Address - Phone:559-907-0110
Mailing Address - Fax:
Practice Address - Street 1:14241 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-5715
Practice Address - Country:US
Practice Address - Phone:559-907-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14568103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist