Provider Demographics
NPI:1225677982
Name:FERMIN, JULIO CESAR (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:CESAR
Last Name:FERMIN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-4046
Mailing Address - Country:US
Mailing Address - Phone:575-546-2174
Mailing Address - Fax:
Practice Address - Street 1:300 S DIAMOND AVE
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3752
Practice Address - Country:US
Practice Address - Phone:575-546-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-76601163WP0808X
NM58948363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health