Provider Demographics
NPI:1235463779
Name:BERMUDO, DIOGENES (PA)
Entity Type:Individual
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First Name:DIOGENES
Middle Name:
Last Name:BERMUDO
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Gender:M
Credentials:PA
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Mailing Address - Street 1:BOX 99116 BLDG 1175
Mailing Address - Street 2:BRANCH HEALTH CLINIC MCAS YUMA
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85369-9116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BLDG 1175
Practice Address - Street 2:MCAS
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85369-9116
Practice Address - Country:US
Practice Address - Phone:928-269-2416
Practice Address - Fax:928-269-3184
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2015-07-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant