Provider Demographics
NPI:1841983491
Name:HERMOSILLO HEALTH LLC
Entity type:Organization
Organization Name:HERMOSILLO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:HERMOSILLO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C, APRN
Authorized Official - Phone:480-299-3761
Mailing Address - Street 1:1124 E SAN CARLOS WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4712
Mailing Address - Country:US
Mailing Address - Phone:480-299-3761
Mailing Address - Fax:
Practice Address - Street 1:3744 S ROME ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7350
Practice Address - Country:US
Practice Address - Phone:480-224-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility