Provider Demographics
NPI:1427600659
Name:HERNANDEZ BERMUDEZ, MAYREM
Entity type:Individual
Prefix:
First Name:MAYREM
Middle Name:
Last Name:HERNANDEZ BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10756 N KENDALL DR APT J12
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1450
Mailing Address - Country:US
Mailing Address - Phone:786-547-7440
Mailing Address - Fax:
Practice Address - Street 1:10756 N KENDALL DR APT J12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1450
Practice Address - Country:US
Practice Address - Phone:786-547-7440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-90447106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty