Healthcare Provider Details

I. General information

NPI: 1659086684
Provider Name (Legal Business Name): ESTEFANY J BEJARANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38527 31ST ST E
PALMDALE CA
93550-4309
US

IV. Provider business mailing address

38527 31ST ST E
PALMDALE CA
93550-4309
US

V. Phone/Fax

Practice location:
  • Phone: 661-202-4397
  • Fax:
Mailing address:
  • Phone: 661-202-4397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number725858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: