Provider Demographics
NPI:1164729091
Name:BEJARANO, JOSE GUILLERMO (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:GUILLERMO
Last Name:BEJARANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 MAPLERIDGE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4629
Mailing Address - Country:US
Mailing Address - Phone:305-984-3442
Mailing Address - Fax:
Practice Address - Street 1:6550 MAPLERIDGE ST STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4629
Practice Address - Country:US
Practice Address - Phone:305-984-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0499132084P0800X
NY2597612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid