Provider Demographics
NPI:1194242370
Name:HERNANDEZ, XOVANNA AZARETH (BCABA)
Entity type:Individual
Prefix:
First Name:XOVANNA
Middle Name:AZARETH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:XOVANNA
Other - Middle Name:AZARETH
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2120 FOOTHILL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-2949
Mailing Address - Country:US
Mailing Address - Phone:909-525-4390
Mailing Address - Fax:909-992-3018
Practice Address - Street 1:2120 FOOTHILL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-2949
Practice Address - Country:US
Practice Address - Phone:909-525-4390
Practice Address - Fax:909-992-3018
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst