Provider Demographics
NPI:1619456142
Name:HERNANDEZ, CARLA ISELA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ISELA
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 1:1608 HERON CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2414
Mailing Address - Country:US
Mailing Address - Phone:909-331-2959
Mailing Address - Fax:
Practice Address - Street 1:9916 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3201
Practice Address - Country:US
Practice Address - Phone:909-450-2502
Practice Address - Fax:909-450-2637
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1278761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical