MEDICARE: JHAYMIE LYNN SALARZON BEJERANA RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	19-79214	GU

General Provider Information

NPI Number	:	1295292365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHAYMIE LYNN SALARZON BEJERANA RBT

Provider Business Mailing Address
First Line	:	PO BOX 20777
Second Line	:
City	:	BARRIGADA
State	:	GU
Zip	:	96921-0777
Country	:	US
Telephone Number	:	671-489-9727
Fax Number	:

Provider Business Practice Location Address
First Line	:	BUILDING 1350 #216
Second Line	:
City	:	UPPER TUMON
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-487-5493
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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