Provider Demographics
NPI:1528784618
Name:PEREZ BERMUDEZ, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:PEREZ 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 1:75299 KELSEY CIR S
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-5317
Mailing Address - Country:US
Mailing Address - Phone:760-534-8465
Mailing Address - Fax:
Practice Address - Street 1:75299 KELSEY CIR S
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-5317
Practice Address - Country:US
Practice Address - Phone:760-534-8465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0065652255A2300X
FLAL55352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer