Individual
GINA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3380 LA SIERRA AVE STE 104-142, RIVERSIDE, CA 92503-5271
(818) 331-6961
Mailing address
3380 LA SIERRA AVE STE 104-142, RIVERSIDE, CA 92503-5271
(818) 331-6961
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
94028528
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDI-CAL
CA
Enumeration date
05/13/2014
Last updated
11/04/2024
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