Provider Demographics
NPI:1588345805
Name:GOVEA-BERMUDEZ, RAUL
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:GOVEA-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 1:2150 S ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-3495
Mailing Address - Country:US
Mailing Address - Phone:754-212-0355
Mailing Address - Fax:866-817-9988
Practice Address - Street 1:2150 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3495
Practice Address - Country:US
Practice Address - Phone:754-212-0352
Practice Address - Fax:866-817-9988
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach