Provider Demographics
NPI:1144489519
Name:HERNANDEZ, DELIA DENISE (LPT)
Entity type:Individual
Prefix:
First Name:DELIA
Middle Name:DENISE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:DELIA
Other - Middle Name:DENISE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:3303 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2803
Mailing Address - Country:US
Mailing Address - Phone:323-478-8200
Mailing Address - Fax:323-221-2022
Practice Address - Street 1:3303 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2803
Practice Address - Country:US
Practice Address - Phone:323-478-8200
Practice Address - Fax:323-221-2022
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30094101YM0800X, 167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health