MEDICARE: DAMIAN BERMUDEZ

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	103K00000X	Behavior Analyst		CA
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1689336299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMIAN BERMUDEZ

Provider Business Mailing Address
First Line	:	6244 EL CAJON BLVD. STE. 14
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4528
Country	:	US
Telephone Number	:	619-206-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	6244 EL CAJON BLVD. STE.14
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4528
Country	:	US
Telephone Number	:	619-206-6166
Fax Number	:

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

Provider Enumeration Date	:	10/11/2021
Last Update Date	:	02/23/2022

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Directions to “ DAMIAN BERMUDEZ ” Practice Location

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