Basic Information
Provider Information
NPI: 1003293796
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: RACHEL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16782 VON KARMAN AVE STE 11
Address2:  
City: IRVINE
State: CA
PostalCode: 926062417
CountryCode: US
TelephoneNumber: 8552237123
FaxNumber: 6193747134
Practice Location
Address1: 1855 2ND ST STE B
Address2:  
City: CONCORD
State: CA
PostalCode: 945192623
CountryCode: US
TelephoneNumber: 8552237123
FaxNumber: 6193747134
Other Information
ProviderEnumerationDate: 05/01/2015
LastUpdateDate: 10/28/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X1-15-18134CAY Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


Home