Healthcare Provider Details

I. General information

NPI: 1275173205
Provider Name (Legal Business Name): JOAQUIN B BERMUDEZ DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E VAN BUREN ST
PHOENIX AZ
85006-3742
US

IV. Provider business mailing address

202 E EARLL DR STE 160
PHOENIX AZ
85012-2636
US

V. Phone/Fax

Practice location:
  • Phone: 602-251-8736
  • Fax:
Mailing address:
  • Phone: 480-490-7106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: JOAQUIN B BERMUDEZ
Title or Position: PROVIDER
Credential: DO PC
Phone: 520-850-6749