Provider Demographics
NPI:1710783535
Name:HERNANDEZ, EMILY A
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17670 CAMINO SONRISA
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92551-6339
Mailing Address - Country:US
Mailing Address - Phone:951-664-4061
Mailing Address - Fax:
Practice Address - Street 1:17670 CAMINO SONRISA
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-6339
Practice Address - Country:US
Practice Address - Phone:951-664-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY1818649106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician