Most Relevant Information
Provider Data
| NPI Number: | 1003536384 |
| Provider Name: | MARK ANTHONY HERNANDEZ |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/29/2022 |
| Last Updated: | 08/29/2022 |
Provider Practice Location
1143 MISSOURI ST
FAIRFIELD
CA
945336007
Practice Location Phone/Fax
| Phone: | 7074359911 |
| Fax: |
Provider Mailing Location
1143 MISSOURI ST
FAIRFIELD
CA
945336007
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |