Individual
AILEEN HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1207 E. FRUIT ST, SANTA ANA, CA 92701-4296
(714) 953-7573
(714) 953-7573
Mailing address
1207 E. FRUIT ST, SANTA ANA, CA 92701-4296
(714) 953-7573
(714) 953-7573
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900654539
PHOENIX HOUSE
CA
Enumeration date
10/25/2018
Last updated
10/25/2018
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