Provider Demographics
NPI:1649088055
Name:HERNANDEZ, JESUS III (MA, BCBA)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:
Last Name:HERNANDEZ
Suffix:III
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13813 TIERRA BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-9329
Mailing Address - Country:US
Mailing Address - Phone:661-889-5222
Mailing Address - Fax:
Practice Address - Street 1:1200 21ST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4606
Practice Address - Country:US
Practice Address - Phone:661-889-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-24-78221103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst