Healthcare Provider Details

I. General information

NPI: 1376688184
Provider Name (Legal Business Name): CASIMIRO BEJERANO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH ST
MIAMI FL
33175-3530
US

IV. Provider business mailing address

PO BOX 650990
MIAMI FL
33265-0990
US

V. Phone/Fax

Practice location:
  • Phone: 305-205-6918
  • Fax: 305-382-8023
Mailing address:
  • Phone: 305-205-6918
  • Fax: 305-382-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9100933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: