Clarissa Justine Hernandez

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

106SOOOOOX Issued in CA

Practice address

11875 Mount Vernon Ave
Grand Terrace, CA 92313-5169

Phone

(909) 572-5299

NPI assigned

Jun 30, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1235709247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19195 US HIGHWAY 18 STE 104",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072562",
            "telephone_number": "888-557-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11875 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135169",
            "telephone_number": "909-572-5299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "CLARISSA",
        "middle_name": "JUSTINE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-30",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "106SOOOOOX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald L Hamby, D.O.
• Rheanna Denise Harrod
• Brian Thomas Haven, DPM
• Health Enterprises
• Health Redesigned
• Gabrielle Hernandez
• Gilbert NMN Hernandez Jr., D.C.
• Madeline Renee Hernandez
• Melody Hernandez
• Liane Hewitt, OTR

• Behavior Technician in Grand Terrace, CA
• Providers in Grand Terrace, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.