Provider Demographics
NPI:1669089918
Name:HERNANDEZ, ERNESTO ARMANDO
Entity type:Individual
Prefix:
First Name:ERNESTO
Middle Name:ARMANDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30290 BUCCANEER BAY UNIT C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-8812
Mailing Address - Country:US
Mailing Address - Phone:951-852-6212
Mailing Address - Fax:
Practice Address - Street 1:1105 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4512
Practice Address - Country:US
Practice Address - Phone:951-439-2943
Practice Address - Fax:951-439-2944
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist