MEDICARE: DR. GEORGE STEPHEN BERMUDEZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY 14014	CA

General Provider Information

NPI Number	:	1568589059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE STEPHEN BERMUDEZ PH.D.

Provider Business Mailing Address
First Line	:	508 CONCHA ST
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-1415
Country	:	US
Telephone Number	:	626-296-1894
Fax Number	:

Provider Business Practice Location Address
First Line	:	97 W BELLEVUE DR
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91105-2501
Country	:	US
Telephone Number	:	626-296-1894
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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