Provider Demographics
NPI:1811723232
Name:HERNANDEZ, VERONICA ALEXANDRIA (CMT)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ALEXANDRIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2560
Mailing Address - Country:US
Mailing Address - Phone:650-283-2693
Mailing Address - Fax:
Practice Address - Street 1:316 BROADWAY
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2560
Practice Address - Country:US
Practice Address - Phone:650-283-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist