Doctor Name: | JEROME HERNANDEZ |
NPI Number: | 1003134099 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | N/A |
License Number: | |
Business Practice Address: | 6160 Mission Gorge Rd San Diego, CA - 921203410 |
Business Phone Number: | 6192813706 |
Business Fax Number: | 6192813714 |
Mailing Address: | 6160 Mission Gorge Rd, SAN DIEGO |
State: | CA |
Postal Code: | 921203410 |
Phone Number: | 6192813706 |
Fax Number: | 6192813714 |
NPI Enumeration Date: | 05/14/2010 |
NPI Last Update Date: | 05/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |