Provider Demographics
NPI:1023349198
Name:HERNANDEZ, CRISTINA FABIOLA (LMFT 115932)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:FABIOLA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMFT 115932
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 2030
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-2030
Mailing Address - Country:US
Mailing Address - Phone:530-228-3813
Mailing Address - Fax:530-228-3813
Practice Address - Street 1:109 PARMAC RD STE 1
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2294
Practice Address - Country:US
Practice Address - Phone:530-891-2945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist