Healthcare Provider Details

I. General information

NPI: 1891369575
Provider Name (Legal Business Name): MEGHANROSE BECKMAN ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 E CARSON ST
LONG BEACH CA
90808-1706
US

IV. Provider business mailing address

4703 MAYBANK AVE
LAKEWOOD CA
90712-3345
US

V. Phone/Fax

Practice location:
  • Phone: 562-938-4108
  • Fax:
Mailing address:
  • Phone: 661-208-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: