Healthcare Provider Details

I. General information

NPI: 1841983491
Provider Name (Legal Business Name): HERMOSILLO HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3744 S ROME ST
GILBERT AZ
85297-7350
US

IV. Provider business mailing address

1124 E SAN CARLOS WAY
CHANDLER AZ
85249-4712
US

V. Phone/Fax

Practice location:
  • Phone: 480-224-9500
  • Fax:
Mailing address:
  • Phone: 480-299-3761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA JOANN HERMOSILLO
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C, APRN
Phone: 480-299-3761