Healthcare Provider Details

I. General information

NPI: 1447685359
Provider Name (Legal Business Name): ROBERT JOSE BERMUDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 PIONEER CT
SAN MATEO CA
94403-1781
US

IV. Provider business mailing address

1123 CHULA VISTA AVE APT 1
BURLINGAME CA
94010-3522
US

V. Phone/Fax

Practice location:
  • Phone: 650-348-6603
  • Fax:
Mailing address:
  • Phone: 650-599-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: