Provider Demographics
NPI:1104086784
Name:BERMUDEZ, JOAQUIN BACA (DO)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:BACA
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:202 E EARLL DR
Mailing Address - Street 2:STE 160
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2636
Mailing Address - Country:US
Mailing Address - Phone:602-239-6880
Mailing Address - Fax:602-239-6988
Practice Address - Street 1:202 E EARLL DR
Practice Address - Street 2:STE 160
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2636
Practice Address - Country:US
Practice Address - Phone:602-239-6880
Practice Address - Fax:602-239-6988
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2019-09-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZR701512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry