Provider Demographics
NPI:1144046467
Name:BEJARANO TELLEZ, YURI LIZETH (CHW)
Entity type:Individual
Prefix:
First Name:YURI
Middle Name:LIZETH
Last Name:BEJARANO TELLEZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:YURI
Other - Middle Name:LIZETH
Other - Last Name:BEJARANO TELLEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:3819 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4004
Mailing Address - Country:US
Mailing Address - Phone:806-220-7326
Mailing Address - Fax:
Practice Address - Street 1:3819 GLENBROOK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4004
Practice Address - Country:US
Practice Address - Phone:806-220-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7838172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker