Provider Demographics
NPI:1841982741
Name:HERNANDEZ, JAQUELINE ELA
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:ELA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HALL ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-6343
Mailing Address - Country:US
Mailing Address - Phone:321-208-3410
Mailing Address - Fax:
Practice Address - Street 1:1448 LILIHA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3589
Practice Address - Country:US
Practice Address - Phone:321-208-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician