Basic Information
| Provider Information | |||||||||
| NPI: | 1639232895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | LUCIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5285 HEATHERLY LN | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926493675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149534455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1440 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927016384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149534455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF39803 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.