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NPI Code Detail

MEDICARE: PETA GAY BEZEK PMHNP-BC

MEDICARE: PETA GAY BEZEK PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerARNP9441794FL
2363LF0000XFamily Nurse Practitioner95027564CA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner10029163OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396281911
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETA GAY BEZEK PMHNP-BC
Provider Business Mailing Address
First Line : 852 E DANENBERG DR
Second Line :
City : EL CENTRO
State : CA
Zip : 92243-8517
Country : US
Telephone Number : 760-344-9951
Fax Number :
Provider Business Practice Location Address
First Line : 1415 W HOBSONWAY
Second Line :
City : BLYTHE
State : CA
Zip : 92225-1479
Country : US
Telephone Number : 760-922-4981
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2017
Last Update Date : 11/26/2025

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