Healthcare Provider Details

I. General information

NPI: 1699734913
Provider Name (Legal Business Name): RITA BROWN BERMUDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 ALHAMBRA BLVD
SACRAMENTO CA
95816-3806
US

IV. Provider business mailing address

630 ALHAMBRA BLVD
SACRAMENTO CA
95816-3806
US

V. Phone/Fax

Practice location:
  • Phone: 916-444-7137
  • Fax: 916-444-7137
Mailing address:
  • Phone: 916-444-7137
  • Fax: 916-444-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG63726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: