Provider Demographics
NPI:1851948970
Name:HERNANDEZ, JULISSA JERRICKA (PPS)
Entity type:Individual
Prefix:
First Name:JULISSA
Middle Name:JERRICKA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28368 ROCHELLE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-5450
Mailing Address - Country:US
Mailing Address - Phone:562-313-3470
Mailing Address - Fax:
Practice Address - Street 1:41399 CHAPEL WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4298
Practice Address - Country:US
Practice Address - Phone:510-657-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230142313101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool