Healthcare Provider Details

I. General information

NPI: 1356903546
Provider Name (Legal Business Name): ILIANA YUSELMY BEJARANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 BEALE ST FL 12
SAN FRANCISCO CA
94105-1823
US

IV. Provider business mailing address

50 BEALE ST FL 12
SAN FRANCISCO CA
94105-1823
US

V. Phone/Fax

Practice location:
  • Phone: 415-547-7800
  • Fax:
Mailing address:
  • Phone: 415-547-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: