Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003090218 |
---|---|
Provider Name | Manuel Hernandez JR. |
First Address | Hanford, CA 93230-1298 |
Second Address | Hanford, CA 93230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2007 |
Last Update Date | 24/12/2007 |