Provider Demographics
NPI:1942675897
Name:BEJAR, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BEJAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3804
Mailing Address - Country:US
Mailing Address - Phone:909-985-2337
Mailing Address - Fax:
Practice Address - Street 1:299 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3804
Practice Address - Country:US
Practice Address - Phone:909-985-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30106ZMedicare PIN
CACA179665Medicare PIN
CACA179664Medicare PIN
CAZZZ23993ZMedicare PIN