Healthcare Provider Details

I. General information

NPI: 1295629343
Provider Name (Legal Business Name): ERIKA FRANCISCA BERMUDEZ TELLO AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BLVD STE 245
BUENA PARK CA
90621-4031
US

IV. Provider business mailing address

2098 N NORDIC ST
ORANGE CA
92865-3943
US

V. Phone/Fax

Practice location:
  • Phone: 714-736-0231
  • Fax:
Mailing address:
  • Phone: 714-597-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1553515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: