Healthcare Provider Details

I. General information

NPI: 1316782378
Provider Name (Legal Business Name): CHRISTOPHER BEUDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BURBANK BLVD
BURBANK CA
91505-2347
US

IV. Provider business mailing address

2501 W BURBANK BLVD
BURBANK CA
91505-2347
US

V. Phone/Fax

Practice location:
  • Phone: 877-929-6863
  • Fax:
Mailing address:
  • Phone: 877-929-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: