Provider Demographics
NPI:1982801379
Name:HERNANDEZ, PAMELA S (MFT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 TERMINO AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-1129
Mailing Address - Country:US
Mailing Address - Phone:951-808-7921
Mailing Address - Fax:951-279-8929
Practice Address - Street 1:101 S KRAEMER BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6105
Practice Address - Country:US
Practice Address - Phone:714-223-7233
Practice Address - Fax:714-223-7233
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist