Healthcare Provider Details

I. General information

NPI: 1093565889
Provider Name (Legal Business Name): CHRSTINE ANN BEJARANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W 9TH ST
SAN PEDRO CA
90731-3711
US

IV. Provider business mailing address

1017 S CENTRE ST APT 105
SAN PEDRO CA
90731-4217
US

V. Phone/Fax

Practice location:
  • Phone: 310-521-9209
  • Fax:
Mailing address:
  • Phone: 310-345-8064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: