Provider Demographics
NPI:1689223091
Name:BERMUDEZ, DORIAN
Entity Type:Individual
Prefix:MR
First Name:DORIAN
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 SW 88TH ST APT A107
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1759
Mailing Address - Country:US
Mailing Address - Phone:786-521-8956
Mailing Address - Fax:
Practice Address - Street 1:6751 SW 88TH ST APT A107
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1759
Practice Address - Country:US
Practice Address - Phone:786-521-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X
FL347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No171R00000XOther Service ProvidersInterpreter