Healthcare Provider Details

I. General information

NPI: 1649186859
Provider Name (Legal Business Name): TE'ANNA MARIE BERMUDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 W LANCASTER BLVD
LANCASTER CA
93534-3108
US

IV. Provider business mailing address

PO BOX 602
RIALTO CA
92377-0602
US

V. Phone/Fax

Practice location:
  • Phone: 661-228-0225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAMFT162796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: