Provider Demographics
NPI:1023747490
Name:HERNANDEZ, VANESSA JUSTINE
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:JUSTINE
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 1:15049 RIVERVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-0546
Mailing Address - Country:US
Mailing Address - Phone:760-265-8354
Mailing Address - Fax:
Practice Address - Street 1:19195 US HIGHWAY 18, SUITE 104, APPLE VALLEY, CA 92307
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307
Practice Address - Country:US
Practice Address - Phone:888-557-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst