Provider Demographics
NPI:1184816217
Name:HERMOSILLO, SAMANTHA ALYSE'
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ALYSE'
Last Name:HERMOSILLO
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 1:2416 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3290
Mailing Address - Country:US
Mailing Address - Phone:714-668-8498
Mailing Address - Fax:
Practice Address - Street 1:2416 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3290
Practice Address - Country:US
Practice Address - Phone:714-668-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health