Healthcare Provider Details

I. General information

NPI: 1164590469
Provider Name (Legal Business Name): MARVIN S. BEITNER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 E SPRING ST SUITE 260
LONG BEACH CA
90815-1423
US

IV. Provider business mailing address

6226 E SPRING ST SUITE 260
LONG BEACH CA
90815-1423
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-6715
  • Fax: 562-429-4556
Mailing address:
  • Phone: 562-421-6715
  • Fax: 562-429-4556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: