Healthcare Provider Details

I. General information

NPI: 1356904536
Provider Name (Legal Business Name): JOHNNALITZ GARCIA BERMUDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6138 WHALTON ST
WEST PALM BEACH FL
33411-6496
US

IV. Provider business mailing address

6138 WHALTON ST
WEST PALM BEACH FL
33411-6496
US

V. Phone/Fax

Practice location:
  • Phone: 561-475-8296
  • Fax:
Mailing address:
  • Phone: 561-475-8296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: