Healthcare Provider Details

I. General information

NPI: 1760545719
Provider Name (Legal Business Name): MR. WARREN GEOFFREY BEDDALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 E SUNSET CT
YUMA AZ
85365-3517
US

IV. Provider business mailing address

1404 E SUNSET CT
YUMA AZ
85365-3517
US

V. Phone/Fax

Practice location:
  • Phone: 928-344-4516
  • Fax:
Mailing address:
  • Phone: 928-344-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number10808
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: