Provider Demographics
NPI:1609201854
Name:HERMOSILLO, PERLA
Entity Type:Individual
Prefix:MISS
First Name:PERLA
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 1:21420 WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8966
Mailing Address - Country:US
Mailing Address - Phone:951-296-7540
Mailing Address - Fax:
Practice Address - Street 1:21420 WALNUT DR
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-8966
Practice Address - Country:US
Practice Address - Phone:951-296-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor