Provider Demographics
NPI:1902410228
Name:BERMUDEZ, GUSTAVO SEBASTIAN
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:SEBASTIAN
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 1:2776 CLIPPER WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-3392
Mailing Address - Country:US
Mailing Address - Phone:239-272-6720
Mailing Address - Fax:
Practice Address - Street 1:2776 CLIPPER WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3392
Practice Address - Country:US
Practice Address - Phone:239-272-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist