# PSYCHIATRY 121 PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366206252
- **Authorized official:** ANGELA G HERNANDEZ PMHNP (MANAGER)
- **Authorized official phone:** (949) 281-9132

## Contact information

- **Practice address:** 1010 W HAYS ST, BOISE, ID 83702-5435
- **Practice address phone:** (949) 281-9132
- **Mailing address:** 1010 W HAYS ST, BOISE, ID 83702-5435

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/12/2024
- **Last updated:** 02/12/2024