Healthcare Provider Details

I. General information

NPI: 1023137106
Provider Name (Legal Business Name): ROBERT STANLEY BERMUDEZ JR. M.A. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 KILAUEA AVE
HILO HI
96720-4201
US

IV. Provider business mailing address

930 N STATE ST
HEMET CA
92543-1473
US

V. Phone/Fax

Practice location:
  • Phone: 808-935-2188
  • Fax:
Mailing address:
  • Phone: 951-765-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-736
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: