Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BP10036751 | TX |
N | 111NI0900X | Internist | BP10036751 | TX |
N | 207RH0003X | Hematology & Oncology | BP20047675 | TX |
Y | 207RH0003X | Hematology & Oncology | DR.0056478 | CO |
NPI | 1003133448 |
---|---|
Provider Name | Dr. Jesus Heliodoro Hermosillo Rodriguez |
First Address | Denver, CO 80247-1314 |
Second Address | Denver, CO 80205-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 14/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027004 | KAISER COMMERCIAL NUMBER (01) | CO |
32155077 | (05) | CO |