Provider Demographics
NPI:1801292594
Name:PEREZ BERMUDEZ, ANGEL ADRIAN
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:ADRIAN
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 1:3442 WILSHIRE WAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7354
Mailing Address - Country:US
Mailing Address - Phone:305-767-8223
Mailing Address - Fax:
Practice Address - Street 1:3442 WILSHIRE WAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-7354
Practice Address - Country:US
Practice Address - Phone:305-767-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)