Healthcare Provider Details

I. General information

NPI: 1902390719
Provider Name (Legal Business Name): BEACHSIDE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 E LIBBY ST
PHOENIX AZ
85032-2094
US

IV. Provider business mailing address

3213 E LIBBY ST
PHOENIX AZ
85032-2094
US

V. Phone/Fax

Practice location:
  • Phone: 602-339-7392
  • Fax:
Mailing address:
  • Phone: 602-339-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code3416S0300X
TaxonomyWater Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MESSEGUER NAJERA
Title or Position: COO
Credential:
Phone: 619-565-1079