Healthcare Provider Details

I. General information

NPI: 1871479402
Provider Name (Legal Business Name): SAMANTHA BEJARANO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ALHAMBRA BLVD
SACRAMENTO CA
95817-1955
US

IV. Provider business mailing address

1886 ALICE WAY
SACRAMENTO CA
95834-2806
US

V. Phone/Fax

Practice location:
  • Phone: 408-710-9982
  • Fax:
Mailing address:
  • Phone: 408-710-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95035373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: