Provider Demographics
NPI:1528754850
Name:BEJARANO, ANEL JUDITH
Entity type:Individual
Prefix:
First Name:ANEL
Middle Name:JUDITH
Last Name:BEJARANO
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 1:23119 COTTONWOOD AVE STE A110
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-6622
Mailing Address - Country:US
Mailing Address - Phone:951-413-5678
Mailing Address - Fax:951-413-5660
Practice Address - Street 1:23119 COTTONWOOD AVE STE A110
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-6622
Practice Address - Country:US
Practice Address - Phone:951-413-5678
Practice Address - Fax:951-413-5660
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 175T00000X
CAMPSS-EGJINU175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker