Provider Demographics
NPI:1124435581
Name:HERNANDEZ, MARTHA LIDIA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LIDIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-4112
Mailing Address - Country:US
Mailing Address - Phone:510-457-5609
Mailing Address - Fax:
Practice Address - Street 1:22366 FULLER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-6226
Practice Address - Country:US
Practice Address - Phone:510-457-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health