Provider Demographics
NPI:1518940774
Name:BERMUDES, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BERMUDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SUNCAST LN STE 108
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9335
Mailing Address - Country:US
Mailing Address - Phone:916-932-0380
Mailing Address - Fax:916-932-0381
Practice Address - Street 1:1020 SUNCAST LN STE 108
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9335
Practice Address - Country:US
Practice Address - Phone:916-932-0380
Practice Address - Fax:916-932-0381
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA853022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05968ZOtherMEDICARE GROUP PIN
CA00A853020Medicaid
CAZZZ05968ZOtherMEDICARE GROUP PIN
CA00A853020Medicaid