Provider Demographics
NPI:1194612838
Name:HERNANDEZ, CARLO
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 CAMINO PLZ # A
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3401
Mailing Address - Country:US
Mailing Address - Phone:650-627-8045
Mailing Address - Fax:
Practice Address - Street 1:7500 SAN FELIPE ST STE 990
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1708
Practice Address - Country:US
Practice Address - Phone:866-610-0580
Practice Address - Fax:866-611-1558
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician