Provider Demographics
NPI:1770022261
Name:BERMUDEZ, HECTOR (CSA)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 YOAKUM PKWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4052
Mailing Address - Country:US
Mailing Address - Phone:301-266-3439
Mailing Address - Fax:
Practice Address - Street 1:300 YOAKUM PKWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4052
Practice Address - Country:US
Practice Address - Phone:301-266-3439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4616246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant