Provider Demographics
NPI:1083017123
Name:HERNANDEZ, MARIA I (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12571 PINON CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4160
Mailing Address - Country:US
Mailing Address - Phone:714-585-2940
Mailing Address - Fax:
Practice Address - Street 1:1435 N HARBOR BLVD # 124
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4105
Practice Address - Country:US
Practice Address - Phone:714-773-0077
Practice Address - Fax:714-773-0067
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-10303103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst