Healthcare Provider Details

I. General information

NPI: 1225609233
Provider Name (Legal Business Name): FERNANDO BERUMEN RRT-NPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

IV. Provider business mailing address

16634 EMERALD BLF
SELMA TX
78154-3928
US

V. Phone/Fax

Practice location:
  • Phone: 210-736-6700
  • Fax:
Mailing address:
  • Phone: 703-927-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License NumberRCP00079334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: