Healthcare Provider Details

I. General information

NPI: 1619337672
Provider Name (Legal Business Name): CLAUDIA BERMUDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 SONOMA AVE
SANTA ROSA CA
95404-4818
US

IV. Provider business mailing address

983 SONOMA AVE
SANTA ROSA CA
95404-4818
US

V. Phone/Fax

Practice location:
  • Phone: 707-909-0576
  • Fax: 800-571-5531
Mailing address:
  • Phone: 707-909-0576
  • Fax: 800-571-5531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: