Healthcare Provider Details

I. General information

NPI: 1679533780
Provider Name (Legal Business Name): BEA MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10070 PASADENA AVE STE 2
CUPERTINO CA
95014-5942
US

IV. Provider business mailing address

10070 PASADENA AVE STE 2
CUPERTINO CA
95014-5942
US

V. Phone/Fax

Practice location:
  • Phone: 408-746-0300
  • Fax:
Mailing address:
  • Phone: 408-746-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberCLM 311477
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberFNP 34120
License Number StateCA

VIII. Authorized Official

Name: DR. LAURA STEVENS
Title or Position: CEO, CFO, PRESIDENT, & FOUNDER
Credential: M.D.
Phone: 408-746-0300