Provider Demographics
NPI:1508221797
Name:HERMOSILLO, DALILA
Entity Type:Individual
Prefix:
First Name:DALILA
Middle Name:
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 1:355 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6492
Mailing Address - Country:US
Mailing Address - Phone:915-328-6187
Mailing Address - Fax:855-533-1402
Practice Address - Street 1:2009 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3418
Practice Address - Country:US
Practice Address - Phone:915-533-1799
Practice Address - Fax:855-533-1402
Is Sole Proprietor?:No
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102094235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist