Healthcare Provider Details

I. General information

NPI: 1730250663
Provider Name (Legal Business Name): LIDIA ROSA BERMUDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 NW 179TH LN
HIALEAH FL
33018-6509
US

IV. Provider business mailing address

8805 NW 179TH LN
HIALEAH FL
33018-6509
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-5501
  • Fax: 305-824-3774
Mailing address:
  • Phone: 305-300-5501
  • Fax: 305-824-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0091458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: