Healthcare Provider Details

I. General information

NPI: 1174502074
Provider Name (Legal Business Name): MYRNA Y BEJAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5652 N MESA ST
EL PASO TX
79912-5425
US

IV. Provider business mailing address

5652 N MESA ST
EL PASO TX
79912-5425
US

V. Phone/Fax

Practice location:
  • Phone: 915-351-1155
  • Fax: 915-351-1230
Mailing address:
  • Phone: 915-351-1155
  • Fax: 915-351-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04168
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: