Provider Demographics
NPI:1154753861
Name:JAIME HERNANDEZ
Entity type:Organization
Organization Name:JAIME HERNANDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CATC
Authorized Official - Phone:650-612-6310
Mailing Address - Street 1:306 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2741
Mailing Address - Country:US
Mailing Address - Phone:650-589-9305
Mailing Address - Fax:650-589-9330
Practice Address - Street 1:306 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-2741
Practice Address - Country:US
Practice Address - Phone:650-589-9305
Practice Address - Fax:650-589-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102476251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health