Healthcare Provider Details

I. General information

NPI: 1841590726
Provider Name (Legal Business Name): VERENISSE BEJARANO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COTTONWOOD ST
WOODLAND CA
95695-5131
US

IV. Provider business mailing address

1321 COTTONWOOD ST
WOODLAND CA
95695-5131
US

V. Phone/Fax

Practice location:
  • Phone: 530-668-2600
  • Fax: 530-666-9840
Mailing address:
  • Phone: 530-668-2600
  • Fax: 530-666-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: