Healthcare Provider Details

I. General information

NPI: 1144690140
Provider Name (Legal Business Name): CHRISTOPHER G BERMUDEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11142 S SCOTTSDALE DR
YUMA AZ
85367-5616
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 928-539-0055
  • Fax: 928-539-0053
Mailing address:
  • Phone: 928-344-2000
  • Fax: 928-539-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberAZ 6066
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6066
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: