Provider Demographics
NPI:1336850973
Name:HERMOSILLO, ASHLEY FAITH
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:FAITH
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 1:11610 MOUNT RAINIER CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-6503
Mailing Address - Country:US
Mailing Address - Phone:909-285-7288
Mailing Address - Fax:
Practice Address - Street 1:10604 N TRADEMARK PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5938
Practice Address - Country:US
Practice Address - Phone:909-484-2848
Practice Address - Fax:909-484-3504
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician