Provider Demographics
NPI:1841590726
Name:BEJARANO, VERENISSE (PA)
Entity Type:Individual
Prefix:
First Name:VERENISSE
Middle Name:
Last Name:BEJARANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5131
Mailing Address - Country:US
Mailing Address - Phone:530-668-2600
Mailing Address - Fax:530-666-9840
Practice Address - Street 1:1321 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5131
Practice Address - Country:US
Practice Address - Phone:530-668-2600
Practice Address - Fax:530-666-9840
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant