Provider Demographics
NPI:1932723541
Name:BENCOMO BERMUDEZ, ISAAC ADRIAN (APRN CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:ADRIAN
Last Name:BENCOMO BERMUDEZ
Suffix:
Gender:M
Credentials:APRN CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 N KANSAS ST APT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3104
Mailing Address - Country:US
Mailing Address - Phone:915-433-1291
Mailing Address - Fax:
Practice Address - Street 1:2418 N KANSAS ST APT A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3104
Practice Address - Country:US
Practice Address - Phone:915-433-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX860434163WP0200X
TXAP141902363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics