Provider Demographics
NPI:1770517526
Name:BERMEJO, JUAN JOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:JOEL
Last Name:BERMEJO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2029
Mailing Address - Country:US
Mailing Address - Phone:661-335-7755
Mailing Address - Fax:661-872-0499
Practice Address - Street 1:2201 MOUNT VERNON AVE
Practice Address - Street 2:STE 109
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3341
Practice Address - Country:US
Practice Address - Phone:661-872-7000
Practice Address - Fax:661-846-7150
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1145231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24180ZMedicare PIN
I19853Medicare UPIN