Healthcare Provider Details

I. General information

NPI: 1265557334
Provider Name (Legal Business Name): GLEN V BEATO P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 JAMACHA ROAD
EL CAJON CA
92019-0000
US

IV. Provider business mailing address

320 BROADWAY STE 2
CHULA VISTA CA
91910-3502
US

V. Phone/Fax

Practice location:
  • Phone: 619-447-7774
  • Fax: 619-447-7779
Mailing address:
  • Phone: 619-422-0404
  • Fax: 619-422-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: