Provider Demographics
NPI:1407497969
Name:HERMOSILLO, SABRINA DEL ROSARIO
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:DEL ROSARIO
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 1:1426 PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2326
Mailing Address - Country:US
Mailing Address - Phone:562-283-6199
Mailing Address - Fax:
Practice Address - Street 1:1426 PETERSON AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2326
Practice Address - Country:US
Practice Address - Phone:562-283-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician