Healthcare Provider Details

I. General information

NPI: 1043007545
Provider Name (Legal Business Name): CRISTOFER IAN MISHLER BERMUDEZ CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 MURPHY CANYON RD
SAN DIEGO CA
92123-4446
US

IV. Provider business mailing address

3870 MURPHY CANYON RD
SAN DIEGO CA
92123-4446
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-0460
  • Fax: 858-300-0461
Mailing address:
  • Phone: 858-300-0460
  • Fax: 858-300-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License NumberRA1030121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: