Provider Demographics
NPI:1730799586
Name:HERNANDEZ, BARBARA JEAN
Entity type:Individual
Prefix:
First Name:BARBARA JEAN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 S. MCCARRAN BLVD
Mailing Address - Street 2:BUILDING D1 UNIT 33
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-1253
Mailing Address - Country:US
Mailing Address - Phone:775-825-7500
Mailing Address - Fax:
Practice Address - Street 1:343 FAIRVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5389
Practice Address - Country:US
Practice Address - Phone:775-887-5683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3747P1801X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant