Provider Demographics
NPI:1457768319
Name:BERMUDEZ, JOSE (DAOM; DIPL OM; LAC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:DAOM; DIPL OM; LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 VICTORY BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6382
Mailing Address - Country:US
Mailing Address - Phone:818-432-1470
Mailing Address - Fax:818-432-1472
Practice Address - Street 1:19231 VICTORY BLVD STE 550
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6382
Practice Address - Country:US
Practice Address - Phone:818-432-1470
Practice Address - Fax:818-432-1472
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist