Provider Demographics
NPI:1659477800
Name:BERMUDEZ, LIVIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LIVIA
Middle Name:M
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 AVE WINSTON CHURCHILL
Mailing Address - Street 2:SUITE 533
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6013
Mailing Address - Country:US
Mailing Address - Phone:787-863-8070
Mailing Address - Fax:
Practice Address - Street 1:303 GENERAL VALERO AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6563207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028258Medicare ID - Type Unspecified
PRD99580Medicare UPIN