Provider Demographics
NPI:1982214995
Name:BERMEJO GUERRA, BEATRIZ (SLP)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:BERMEJO GUERRA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 68TH ST STE E&F
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4579
Mailing Address - Country:US
Mailing Address - Phone:786-602-0081
Mailing Address - Fax:
Practice Address - Street 1:1301 W 68TH ST STE E&F
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4579
Practice Address - Country:US
Practice Address - Phone:786-602-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist