Provider Demographics
NPI:1063250066
Name:BERMUDEZ, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
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 1:9326 HAITIAN DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1646
Mailing Address - Country:US
Mailing Address - Phone:786-423-0219
Mailing Address - Fax:
Practice Address - Street 1:9326 HAITIAN DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1646
Practice Address - Country:US
Practice Address - Phone:786-423-0219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-360367106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician