Basic Information
| Provider Information | |||||||||
| NPI: | 1497364509 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERMUDEZ | ||||||||
| FirstName: | NYKIA | ||||||||
| MiddleName: | BELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 816 FOX MOUNTAIN CT | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890842564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028580827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 S RANCHO DR STE A10 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891064898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024374673 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2020 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 8700-S | NV | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.