MEDICARE: DR. ELLIS NORMAN BEESLEY JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	A41548	CA

General Provider Information

NPI Number	:	1063470219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIS NORMAN BEESLEY JR. M.D.

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 707
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-482-4830
Fax Number	:	213-482-0275

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 707
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3901
Country	:	US
Telephone Number	:	213-482-4830
Fax Number	:	213-482-0275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/21/2021

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