Provider Demographics
NPI:1699734913
Name:BERMUDEZ, RITA BROWN (MD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:BROWN
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ALHAMBRA BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3806
Mailing Address - Country:US
Mailing Address - Phone:916-444-7137
Mailing Address - Fax:916-444-7137
Practice Address - Street 1:630 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3806
Practice Address - Country:US
Practice Address - Phone:916-444-7137
Practice Address - Fax:916-444-7137
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63726208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63726OtherSTATE MEDICAL LISENCE
CA00G637260Medicare ID - Type Unspecified
CAE91192Medicare UPIN