Individual provider Active NPI

Mirna Veronica Hernandez Saldivar

  • Clinical Social Worker
  • Ontario, CA
National Provider Identifier
1154725521
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW97601 Issued in CA
Practice address
855 N Euclid Ave
Ontario, CA 91762-2729
Phone
(909) 983-2020
NPI assigned
Oct 14, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW97601 CA Primary
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

855 N Euclid Ave
Ontario, CA 91762-2729

Mailing address

855 N Euclid Ave
Ontario, CA 91762-2729
Phone (909) 983-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240319002201 CA Practitioner - Clinical Social Worker 5890132435 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Soultenders IncGroup PAC ID 6507170453, 113 clinicians

Practice addresses (Care Compare)

10532 Acacia St
Suite B4
Rancho Cucamonga, CA 91730-5455
Phone (909) 325-3766

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCSW97601CAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Wise Mind Counseling Services Inc. CurrentSince Jan 31, 2024 Accepting new patients
Soultenders, Inc. Mental Health CurrentSince Aug 12, 2024 Accepting new patients

Locations

41 E Foothill Blvd
Ste 102
Arcadia, CA 91006
Phone (626) 701-4249

10532 Acacia St
Ste B4
Rch Cucamonga, CA 91730
Phone (909) 325-3766

11801 Pierce St
Ste 200
Riverside, CA 92505
Phone (323) 547-2662

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605225600000",
    "number": "1154725521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 N EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917622729",
            "telephone_number": "909-983-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 N EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917622729",
            "telephone_number": "909-983-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ SALDIVAR",
        "first_name": "MIRNA",
        "middle_name": "VERONICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-14",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW97601",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.