Provider Demographics
NPI:1336775998
Name:HERNANDEZ, CINTHYA (MA, EDS)
Entity type:Individual
Prefix:
First Name:CINTHYA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 TWINING AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2551
Mailing Address - Country:US
Mailing Address - Phone:619-690-9222
Mailing Address - Fax:
Practice Address - Street 1:849 TWINING AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-2551
Practice Address - Country:US
Practice Address - Phone:619-690-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170119182103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool