Healthcare Provider Details

I. General information

NPI: 1346791852
Provider Name (Legal Business Name): CARLOS HERNAN BERMUDEZ NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 7TH ST
SAN FRANCISCO CA
94103-4030
US

IV. Provider business mailing address

356 7TH ST
SAN FRANCISCO CA
94103-4030
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-6677
  • Fax: 628-217-6610
Mailing address:
  • Phone: 628-217-6677
  • Fax: 626-217-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005040
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95005040
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95005040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: