Healthcare Provider Details

I. General information

NPI: 1689223091
Provider Name (Legal Business Name): MR. DORIAN BERMUDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 SW 88TH ST APT A107
PINECREST FL
33156-1759
US

IV. Provider business mailing address

6751 SW 88TH ST APT A107
PINECREST FL
33156-1759
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-8956
  • Fax:
Mailing address:
  • Phone: 786-521-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: