Provider Demographics
NPI:1326287889
Name:JOSEPH P HERMOSA MD PLLC
Entity Type:Organization
Organization Name:JOSEPH P HERMOSA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:512-630-1969
Mailing Address - Street 1:402A W PALM VALLEY BLVD # 305
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4237
Mailing Address - Country:US
Mailing Address - Phone:512-360-1969
Mailing Address - Fax:512-240-5026
Practice Address - Street 1:7230 WYOMING SPRINGS DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4319
Practice Address - Country:US
Practice Address - Phone:512-360-1969
Practice Address - Fax:512-240-5026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH P HERMOSA MD PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-06
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4435174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162627701Medicaid
TX854488OtherMEDICARE