Healthcare Provider Details

I. General information

NPI: 1306144837
Provider Name (Legal Business Name): BEAUTIFUL MINDS MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 NEW AIRPORT RD STE 100
AUBURN CA
95602-7407
US

IV. Provider business mailing address

13300 NEW AIRPORT RD STE 100
AUBURN CA
95602-7407
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-8780
  • Fax: 530-889-8781
Mailing address:
  • Phone: 530-889-8780
  • Fax: 530-889-8781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA100710
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL L BINUS
Title or Position: PRESIDENT
Credential: MD
Phone: 909-583-3596