Provider Demographics
NPI:1306885124
Name:HERMOSA, JOSEPH P (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:HERMOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402A W PALM VALLEY BLVD # 350
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4237
Mailing Address - Country:US
Mailing Address - Phone:512-630-1969
Mailing Address - Fax:512-240-5026
Practice Address - Street 1:402A W PALM VALLEY BLVD # 350
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4237
Practice Address - Country:US
Practice Address - Phone:512-630-1969
Practice Address - Fax:512-240-5026
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162627701Medicaid
TXH93144Medicare UPIN
TX609878Medicare ID - Type UnspecifiedMEDICARE #