Healthcare Provider Details

I. General information

NPI: 1225677982
Provider Name (Legal Business Name): JULIO CESAR FERMIN PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2019
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S DIAMOND AVE
DEMING NM
88030-3752
US

IV. Provider business mailing address

901 W HICKORY ST
DEMING NM
88030-4046
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-2174
  • Fax:
Mailing address:
  • Phone: 575-546-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-76601
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number58948
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: