Healthcare Provider Details

I. General information

NPI: 1407548159
Provider Name (Legal Business Name): HERMOSILLO FAMILY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 07/18/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 LAKES DR STE 250
WEST COVINA CA
91790-2933
US

IV. Provider business mailing address

PO BOX 32252
LOS ANGELES CA
90032-0252
US

V. Phone/Fax

Practice location:
  • Phone: 323-215-9491
  • Fax: 323-307-7712
Mailing address:
  • Phone: 323-382-8318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. DESIREE RENAE HERMOSILLO
Title or Position: OWNER/MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 323-474-9288