Provider Demographics
NPI:1235845173
Name:BERMUDEZ, ROSA E (MT)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:E
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S. RANCHO DR
Mailing Address - Street 2:STE 113-B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-509-5098
Mailing Address - Fax:702-924-6356
Practice Address - Street 1:600 S RANCHO DR
Practice Address - Street 2:STE 113-B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-509-5098
Practice Address - Fax:702-924-6356
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.2536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist