MEDICARE: MS. KARINA ALEJANDRA HERMOSILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	104893	CA

General Provider Information

NPI Number	:	1588092837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARINA ALEJANDRA HERMOSILLO

Provider Business Mailing Address
First Line	:	7820 PALM ST
Second Line	:
City	:	LEMON GROVE
State	:	CA
Zip	:	91945-2953
Country	:	US
Telephone Number	:	619-587-7108
Fax Number	:

Provider Business Practice Location Address
First Line	:	1706 SANTA GLORIA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-6703
Country	:	US
Telephone Number	:	619-587-7108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2013
Last Update Date	:	06/11/2024

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