Healthcare Provider Details

I. General information

NPI: 1467406611
Provider Name (Legal Business Name): BEACH FAMILY DOCTORS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 ADAMS AVE
HUNTINGTON BEACH CA
92646-3462
US

IV. Provider business mailing address

PO BOX 15775
NEWPORT BEACH CA
92659-5775
US

V. Phone/Fax

Practice location:
  • Phone: 714-845-5906
  • Fax: 714-845-5922
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIA HARRIS
Title or Position: PARTNER
Credential: M.D.
Phone: 714-845-5900