Provider Demographics
NPI:1487427522
Name:HERNANDEZ, KIARA YVANNA
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:YVANNA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33280 BIG RANGE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-2243
Mailing Address - Country:US
Mailing Address - Phone:626-353-5933
Mailing Address - Fax:
Practice Address - Street 1:4160 TEMESCAL CANYON RD STE 309
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-4629
Practice Address - Country:US
Practice Address - Phone:626-353-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health