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General NPI Number Information
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NPI Number | 1891563987
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Entity Type | Individual
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Provider Name | JORGE LUIS BERMUDEZ AMFT
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Gender | Male
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 5601 W SLAUSON AVE STE 192
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City | CULVER CITY
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State | CA
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Zip | 90230-6569
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Country | US
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Telephone | 424-331-9070
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Fax |
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Provider Business Mailing Address
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Address Line | 135 W ELLIS AVE
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City | INGLEWOOD
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State | CA
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Zip | 90302-1248
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Country | US
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Telephone | 310-242-3421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 117699
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License Number State | CA
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