Healthcare Provider Details

I. General information

NPI: 1891746624
Provider Name (Legal Business Name): EDGARDO BERMUDEZ MORENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAINT LUKES MEMORIAL HOSPITAL 909 AVE TITO CASTRO CARR 14
PONCE PR
00731
US

IV. Provider business mailing address

PO BOX 7334
PONCE PR
00732-7334
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-0550
  • Fax: 787-813-0566
Mailing address:
  • Phone: 787-813-0550
  • Fax: 787-813-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number10593
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: