Healthcare Provider Details

I. General information

NPI: 1699164053
Provider Name (Legal Business Name): ESTEFANIA HERMOSILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CITY PKWY W STE 200
ORANGE CA
92868-2941
US

IV. Provider business mailing address

920 16TH ST STE B
MODESTO CA
95354-1119
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6751
  • Fax:
Mailing address:
  • Phone: 209-522-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: