Provider Demographics
NPI:1750182044
Name:BEJERANO, NIURIS
Entity type:Individual
Prefix:
First Name:NIURIS
Middle Name:
Last Name:BEJERANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 N 56TH AVE APT 233
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2257
Mailing Address - Country:US
Mailing Address - Phone:786-760-4939
Mailing Address - Fax:
Practice Address - Street 1:3610 N 56TH AVE APT 233
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2257
Practice Address - Country:US
Practice Address - Phone:786-760-4939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-1932-921127106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician