Healthcare Provider Details

I. General information

NPI: 1841534377
Provider Name (Legal Business Name): IRMA JO BEJARANO RDHAP, MHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 KENSINGTON PL
COVINA CA
91724-2651
US

IV. Provider business mailing address

808 KENSINGTON PL
COVINA CA
91724-2651
US

V. Phone/Fax

Practice location:
  • Phone: 909-896-6698
  • Fax:
Mailing address:
  • Phone: 909-896-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberHAP397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: