Provider Demographics
NPI:1992251532
Name:HERNANDEZ, JOSE GERMAN (BS)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GERMAN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 BLUEROCK DR. NE
Mailing Address - Street 2:
Mailing Address - City:EAST WENTCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802
Mailing Address - Country:US
Mailing Address - Phone:509-662-6761
Mailing Address - Fax:
Practice Address - Street 1:4083 BLUE ROCK DR NE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-9000
Practice Address - Country:US
Practice Address - Phone:509-662-6761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60620351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health