Healthcare Provider Details

I. General information

NPI: 1053972364
Provider Name (Legal Business Name): BERNARD BUEMIO LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 E EL CAMINO REAL
SUNNYVALE CA
94087-7719
US

IV. Provider business mailing address

6602 VIENNA DR
CORPUS CHRISTI TX
78414-3942
US

V. Phone/Fax

Practice location:
  • Phone: 408-720-8498
  • Fax:
Mailing address:
  • Phone: 361-443-6538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number49692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: