Healthcare Provider Details

I. General information

NPI: 1578938981
Provider Name (Legal Business Name): BEACH FAMILY DOCTORS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 ADAMS AVE
HUNTINGTON BEACH CA
92648
US

IV. Provider business mailing address

9131 ADAMS AVE
HUNTINGTON BEACH CA
92648
US

V. Phone/Fax

Practice location:
  • Phone: 714-845-5900
  • Fax:
Mailing address:
  • Phone: 714-845-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number95002827
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number95002827
License Number StateCA

VIII. Authorized Official

Name: ANDREW MLEYNEK
Title or Position: MANAGING PARTNER
Credential: DO
Phone: 714-845-5900