Provider Demographics
NPI:1740025840
Name:HERNANDEZ, PETER THOMAS II
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:THOMAS
Last Name:HERNANDEZ
Suffix:II
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 1:4755 BEATTY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2308
Mailing Address - Country:US
Mailing Address - Phone:951-463-0880
Mailing Address - Fax:
Practice Address - Street 1:4755 BEATTY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2308
Practice Address - Country:US
Practice Address - Phone:951-463-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT139846106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist