Healthcare Provider Details

I. General information

NPI: 1275909459
Provider Name (Legal Business Name): STEPHANIE BERMUDEZ RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 10/19/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 1065
RINCON PR
00677-1065
US

V. Phone/Fax

Practice location:
  • Phone: 178-784-4208
  • Fax:
Mailing address:
  • Phone: 787-599-9375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19877
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: