Provider Demographics
NPI:1376082941
Name:BEJERANO, DIANE GRACE (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:GRACE
Last Name:BEJERANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15453 W SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-7217
Mailing Address - Country:US
Mailing Address - Phone:626-278-0127
Mailing Address - Fax:
Practice Address - Street 1:523 ROSE LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1448
Practice Address - Country:US
Practice Address - Phone:928-668-1833
Practice Address - Fax:928-684-7457
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNONE YET207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine