Provider Demographics
NPI:1841772894
Name:BEJERANO, LUIS E
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:E
Last Name:BEJERANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 NW 7TH ST APT B214
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3252
Mailing Address - Country:US
Mailing Address - Phone:347-869-8163
Mailing Address - Fax:
Practice Address - Street 1:5601 NW 7TH ST APT B214
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3252
Practice Address - Country:US
Practice Address - Phone:347-869-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician