Provider Demographics
NPI:1508662172
Name:HERNANDEZ, JACOB LINCOLN (BT)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:LINCOLN
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4874
Mailing Address - Country:US
Mailing Address - Phone:657-247-9163
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN ST STE 600
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4514
Practice Address - Country:US
Practice Address - Phone:714-542-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician