Provider Demographics
NPI:1972154466
Name:HERNANDEZ, LILIAN MARIE (MS)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N PRAIRIE AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4513
Mailing Address - Country:US
Mailing Address - Phone:323-796-0353
Mailing Address - Fax:
Practice Address - Street 1:301 N PRAIRIE AVE STE 601
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4513
Practice Address - Country:US
Practice Address - Phone:323-796-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst