Provider Demographics
NPI:1174085419
Name:PASCUAL BERMUDEZ, YISCEL MARIA
Entity type:Individual
Prefix:
First Name:YISCEL
Middle Name:MARIA
Last Name:PASCUAL BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 SW 227TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1947
Mailing Address - Country:US
Mailing Address - Phone:786-740-0516
Mailing Address - Fax:
Practice Address - Street 1:9333 SW 227TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1947
Practice Address - Country:US
Practice Address - Phone:786-740-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM102551251B00000X
FLCBHCMS0102588171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management