Healthcare Provider Details

I. General information

NPI: 1770475121
Provider Name (Legal Business Name): ELIJAH BEJARANO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 GRAND AVE STE 300J
EVERETT WA
98201-3586
US

IV. Provider business mailing address

PO BOX 1993
GRANITE FALLS WA
98252-1993
US

V. Phone/Fax

Practice location:
  • Phone: 425-218-5405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMASS.MA.61664995
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: