Healthcare Provider Details

I. General information

NPI: 1861644486
Provider Name (Legal Business Name): KARLA BEJOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 N CAMINO DEL PUEBLO
BERNALILLO NM
87004-6146
US

IV. Provider business mailing address

224 N . CAMINO DEL PUEBLO
BERNALILLO NM
87004-6013
US

V. Phone/Fax

Practice location:
  • Phone: 505-404-5716
  • Fax:
Mailing address:
  • Phone: 505-404-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4568
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: