Provider Demographics
NPI:1720015670
Name:HERNANDEZ-FALK, ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ-FALK
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:45080 GOLF CENTER PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-7310
Mailing Address - Country:US
Mailing Address - Phone:760-342-8344
Mailing Address - Fax:760-342-8345
Practice Address - Street 1:45080 GOLF CENTER PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-7310
Practice Address - Country:US
Practice Address - Phone:760-342-8344
Practice Address - Fax:760-342-8344
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 20746104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ255052Medicare ID - Type Unspecified111103