Provider Demographics
NPI:1992471528
Name:HERNANDEZ, MONICA T (SUDRC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:T
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 WEST ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3827
Mailing Address - Country:US
Mailing Address - Phone:831-524-6547
Mailing Address - Fax:
Practice Address - Street 1:1201 ECHO AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-3719
Practice Address - Country:US
Practice Address - Phone:831-524-6547
Practice Address - Fax:831-753-5169
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10859OtherSUDRC