Healthcare Provider Details

I. General information

NPI: 1386146322
Provider Name (Legal Business Name): LORIANN BEJARANO LMSW-ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 1ST ST # 969
TUSTIN CA
92780-3211
US

IV. Provider business mailing address

360 E 1ST ST # 969
TUSTIN CA
92780-3211
US

V. Phone/Fax

Practice location:
  • Phone: 619-788-8609
  • Fax:
Mailing address:
  • Phone: 619-788-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number90981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: