Healthcare Provider Details

I. General information

NPI: 1801370804
Provider Name (Legal Business Name): LUZ BEJARANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11124 WURZBACH RD STE 100
SAN ANTONIO TX
78230-2440
US

IV. Provider business mailing address

11124 WURZBACH RD STE 100
SAN ANTONIO TX
78230-2440
US

V. Phone/Fax

Practice location:
  • Phone: 210-615-5242
  • Fax:
Mailing address:
  • Phone: 210-615-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number800379
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: