Healthcare Provider Details

I. General information

NPI: 1033512868
Provider Name (Legal Business Name): MARIETTA BERMUDEZ GUAJARDO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIETTA MENESES BERMUDEZ NP

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 COFFEE RD
MODESTO CA
95355-4201
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-1211
  • Fax: 209-550-4830
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126286
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95005262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: