Healthcare Provider Details

I. General information

NPI: 1346053121
Provider Name (Legal Business Name): BEULAH JEBARAJ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S STRATFORD AVE STE B
SANTA MARIA CA
93454-5908
US

IV. Provider business mailing address

2747 STEPHEN PL
SANTA MARIA CA
93455-7470
US

V. Phone/Fax

Practice location:
  • Phone: 805-332-8446
  • Fax: 805-332-8483
Mailing address:
  • Phone: 805-867-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95033700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: