Basic Information
| Provider Information | |||||||||
| NPI: | 1467647172 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | JEANNET | ||||||||
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| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 BUSINESS CENTER DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098905950 | ||||||||
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| Practice Location | |||||||||
| Address1: | 820 E GILBERT ST | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924153436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9093877200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 01/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MFTI 54220 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 53800 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.