Healthcare Provider Details

I. General information

NPI: 1851169080
Provider Name (Legal Business Name): MARTHA BEJERANO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

IV. Provider business mailing address

1400 NW 12TH AVE
MIAMI FL
33136-1003
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-2618
  • Fax: 305-689-5791
Mailing address:
  • Phone: 305-689-2618
  • Fax: 305-689-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11030398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: