Provider Demographics
NPI:1558015925
Name:BERMUDEZ, REGINA CORDOVA
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:CORDOVA
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 SAINT ROSE PKWY UNIT 1337
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3531
Mailing Address - Country:US
Mailing Address - Phone:702-800-1885
Mailing Address - Fax:
Practice Address - Street 1:3140 SAINT ROSE PKWY UNIT 1337
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3531
Practice Address - Country:US
Practice Address - Phone:702-800-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant