Provider Demographics
NPI:1013674910
Name:HERNANDEZ, LINDA GUADALUPE
Entity type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:GUADALUPE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:GUADALUPE
Other - Last Name:HERNANDEZ- RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:72877 DINAH SHORE DR # 103-416
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2763
Mailing Address - Country:US
Mailing Address - Phone:514-729-1479
Mailing Address - Fax:
Practice Address - Street 1:72877 DINAH SHORE DR # 103-416
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2763
Practice Address - Country:US
Practice Address - Phone:951-472-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician