Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 26590 | CA |
Y | 103T00000X | Psychologist | 26590 | CA |
NPI | 1003205642 |
---|---|
Provider Name | Dr. Sara Clancy Hernandez |
First Address | Irvine, CA 92612-4684 |
Second Address | Irvine, CA 92612-4684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2015 |
Last Update Date | 06/03/2015 |