Provider Demographics
NPI:1831553379
Name:HERNANDEZ, BLANCA
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:HERNANDEZ-COVARRUBIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-1085
Mailing Address - Country:US
Mailing Address - Phone:775-442-1089
Mailing Address - Fax:
Practice Address - Street 1:325 11TH ST
Practice Address - Street 2:1
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419
Practice Address - Country:US
Practice Address - Phone:775-442-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst