Individual provider Active NPI

Gina Hernandez

  • Clinical Psychologist
  • Riverside, CA
National Provider Identifier
1740691757
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
94028528 Issued in CA
Practice address
3380 La Sierra Ave Ste 104-142
Riverside, CA 92503-5271
Phone
(818) 331-6961
NPI assigned
May 13, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Student in an Organized Health Care Education/Training Program 390200000X
Clinical Psychologist 103TC0700X 94028528 CA Primary

Addresses

Primary practice location

3380 La Sierra Ave Ste 104-142
Riverside, CA 92503-5271

Mailing address

3380 La Sierra Ave Ste 104-142
Riverside, CA 92503-5271
Phone (818) 331-6961

Other practice location 1

1625 Schrader Blvd
Los Angeles, CA 90028-6213
Phone (323) 993-2928

Other identifiers 1

IdentifierTypeStateIssuer
01536011OtherCAMEDI-CAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • 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
I20241003001591 CA Practitioner - Clinical Psychologist 6204367055 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pure Autism Counseling Center Inc CurrentSince Jul 26, 2024 Accepting new patients

Locations

17702 Sierra Hwy
Santa Clarita, CA 91351
Phone (888) 770-5222

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/19641/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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": "1399939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1740691757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3380 LA SIERRA AVE STE 104-142",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035271",
            "telephone_number": "818-331-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 LA SIERRA AVE STE 104-142",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035271",
            "telephone_number": "818-331-6961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 Schrader Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900286213",
            "country_code": "US",
            "telephone_number": "323-993-2928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "GINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-13",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "94028528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "01536011",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.