Provider Demographics
NPI:1992847966
Name:HERNANDEZ, DANIELLE YVETTE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:YVETTE
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 1:124 CARMEN LN STE J-L
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7768
Mailing Address - Country:US
Mailing Address - Phone:805-928-8622
Mailing Address - Fax:805-739-8863
Practice Address - Street 1:1722 SOUTH LEWIS ROAD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93013
Practice Address - Country:US
Practice Address - Phone:805-928-8622
Practice Address - Fax:805-739-8863
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist