Healthcare Provider Details

I. General information

NPI: 1801993480
Provider Name (Legal Business Name): ADAMS BEJARANO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 CERRILLOS RD
SANTA FE NM
87501-3784
US

IV. Provider business mailing address

PO BOX 31428
SANTA FE NM
87594-1428
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-4797
  • Fax: 505-989-8683
Mailing address:
  • Phone: 505-690-4797
  • Fax: 505-989-8683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number729
License Number StateNM

VIII. Authorized Official

Name: DR. JAMES HARRISON ADAMS
Title or Position: OWNER MEMBER
Credential: PHD
Phone: 505-690-4797