Healthcare Provider Details

I. General information

NPI: 1831993633
Provider Name (Legal Business Name): ASHLEY GUADALUPE BEJARANO GOMEZ CPR CERTIFICATION
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

IV. Provider business mailing address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

V. Phone/Fax

Practice location:
  • Phone: 805-348-1850
  • Fax:
Mailing address:
  • Phone: 805-212-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: