Basic Information
| Provider Information | |||||||||
| NPI: | 1265189658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | GEMMA | ||||||||
| MiddleName: | RUBY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3433 W SHAW AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937113229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595584051 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 496 S BARTON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937022985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5598604422 | ||||||||
| FaxNumber: | 5594757866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2022 | ||||||||
| LastUpdateDate: | 03/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.