Healthcare Provider Details

I. General information

NPI: 1144248477
Provider Name (Legal Business Name): JOHN P BEAUCLAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E HUNTINGTON DR
ARCADIA CA
91006-3212
US

IV. Provider business mailing address

229 MONARCH BAY DR
DANA POINT CA
92629-3436
US

V. Phone/Fax

Practice location:
  • Phone: 626-445-0326
  • Fax: 626-446-5155
Mailing address:
  • Phone: 626-696-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG17614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: