Healthcare Provider Details

I. General information

NPI: 1366439200
Provider Name (Legal Business Name): BEACH PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD STE 215
HUNTINGTON BEACH CA
92647-6818
US

IV. Provider business mailing address

17742 BEACH BLVD STE 215
HUNTINGTON BEACH CA
92647-6818
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-1655
  • Fax: 714-847-4348
Mailing address:
  • Phone: 714-848-1655
  • Fax: 714-847-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ARNOLD J BRENDER
Title or Position: PRESIDENT
Credential: MD
Phone: 714-848-1655