Healthcare Provider Details

I. General information

NPI: 1497470223
Provider Name (Legal Business Name): ARIANNA YSABEL BEJARANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

662 ENCINITAS BLVD STE 208
ENCINITAS CA
92024-6789
US

IV. Provider business mailing address

1296 MILLBROOK RD
CORONA CA
92882-5866
US

V. Phone/Fax

Practice location:
  • Phone: 760-634-1125
  • Fax:
Mailing address:
  • Phone: 951-818-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: