Provider Demographics
NPI:1396889846
Name:HERNANDEZ, VICTOR JR (LMFT)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:VICTOR
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:15507 S NORMANDIE AVE # 143
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4013
Mailing Address - Country:US
Mailing Address - Phone:714-719-8428
Mailing Address - Fax:323-345-5483
Practice Address - Street 1:24520 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6800
Practice Address - Country:US
Practice Address - Phone:714-719-8428
Practice Address - Fax:323-345-5483
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51129106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty