Provider Demographics
NPI:1336799493
Name:HERNANDEZ, TRASK ROBERT (CADCII)
Entity Type:Individual
Prefix:
First Name:TRASK
Middle Name:ROBERT
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4982
Mailing Address - Country:US
Mailing Address - Phone:909-981-2171
Mailing Address - Fax:909-981-2031
Practice Address - Street 1:1260 E ARROW HWY BLDG B
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4996
Practice Address - Country:US
Practice Address - Phone:909-981-2171
Practice Address - Fax:909-981-2031
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054070318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)