Provider Demographics
NPI:1043004781
Name:HERNANDEZ, MICHELLE DOLORES
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOLORES
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28245 AVE CROCKER
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:
Practice Address - Street 1:28245 AVE CROCKER
Practice Address - Street 2:SUITE 220
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-254-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician