Healthcare Provider Details

I. General information

NPI: 1750860946
Provider Name (Legal Business Name): DANIEL BEJARANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41521 W 11 MILE RD
NOVI MI
48375-1803
US

IV. Provider business mailing address

41521 W 11 MILE RD
NOVI MI
48375-1803
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0300
  • Fax:
Mailing address:
  • Phone: 248-912-1667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: