Provider Demographics
NPI:1144690140
Name:BERMUDEZ, CHRISTOPHER G (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7127
Mailing Address - Country:US
Mailing Address - Phone:928-344-2000
Mailing Address - Fax:928-539-0053
Practice Address - Street 1:11142 S SCOTTSDALE DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5616
Practice Address - Country:US
Practice Address - Phone:928-539-0055
Practice Address - Fax:928-539-0053
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 6066363AM0700X
AZ6066363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical