Provider Demographics
NPI:1336613066
Name:HERNANDEZ, JENNIFER JOANNE (MS, APCC)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:JOANNE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S PICO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-4130
Mailing Address - Country:US
Mailing Address - Phone:951-292-5790
Mailing Address - Fax:
Practice Address - Street 1:625 S PICO AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4130
Practice Address - Country:US
Practice Address - Phone:951-292-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5427101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional