Provider Demographics
NPI:1730796970
Name:BEJARANO, DONNA LATREECE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LATREECE
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 1:6418 ECKHERT RD APT 6302
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3151
Mailing Address - Country:US
Mailing Address - Phone:210-996-9188
Mailing Address - Fax:
Practice Address - Street 1:6418 ECKHERT RD APT 6302
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3151
Practice Address - Country:US
Practice Address - Phone:210-996-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328930164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse