MEDICARE: PROF. LARISA DAGNE BERMEJO MA

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	111N00000X	Chiropractor	CH9342	FL

General Provider Information

NPI Number	:	1598099590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. LARISA DAGNE BERMEJO MA

Provider Business Mailing Address
First Line	:	85 GRAND CANAL DR STE 310
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2570
Country	:	US
Telephone Number	:	305-263-8228
Fax Number	:	305-263-8236

Provider Business Practice Location Address
First Line	:	85 GRAND CANAL DR STE 310
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144-2570
Country	:	US
Telephone Number	:	305-263-8228
Fax Number	:	305-263-8236

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

Provider Enumeration Date	:	09/23/2009
Last Update Date	:	09/23/2009

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