Provider Demographics
NPI:1164659272
Name:HERMOSILLO, ELIZABETH F (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:F
Last Name:HERMOSILLO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12670 COMETA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1148
Mailing Address - Country:US
Mailing Address - Phone:818-571-5338
Mailing Address - Fax:
Practice Address - Street 1:12670 COMETA AVE
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1148
Practice Address - Country:US
Practice Address - Phone:818-571-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist