Healthcare Provider Details

I. General information

NPI: 1164729091
Provider Name (Legal Business Name): JOSE GUILLERMO BEJARANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MAPLERIDGE ST STE 106
HOUSTON TX
77081-4629
US

IV. Provider business mailing address

6550 MAPLERIDGE ST STE 106
HOUSTON TX
77081-4629
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-3442
  • Fax:
Mailing address:
  • Phone: 305-984-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number049913
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number259761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: