Healthcare Provider Details

I. General information

NPI: 1962488270
Provider Name (Legal Business Name): ELIZABETH GEORGINA BEAZLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 VIA OTANO
OCEANSIDE CA
92056-5664
US

IV. Provider business mailing address

1579 VIA OTANO
OCEANSIDE CA
92056-5664
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1400
  • Fax:
Mailing address:
  • Phone: 760-724-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGFE83181
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: