Individual
GARY R HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
14677 MERRILL AV., FONTANA, CA 92335
(951) 643-2350
Mailing address
2020 IOWA AVE, STE 101, RIVERSIDE, CA 92507-0520
(951) 235-4055
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT36206
CA
Other
Enumeration date
03/27/2012
Last updated
02/14/2019
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