Provider Demographics
NPI:1780470989
Name:HERNANDEZ, MAGDA MARISOL
Entity type:Individual
Prefix:
First Name:MAGDA
Middle Name:MARISOL
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 W 131ST ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1711
Mailing Address - Country:US
Mailing Address - Phone:310-704-1281
Mailing Address - Fax:
Practice Address - Street 1:803 W 131ST ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-1711
Practice Address - Country:US
Practice Address - Phone:310-704-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician