Healthcare Provider Details

I. General information

NPI: 1174006936
Provider Name (Legal Business Name): ANGELIQUE MARIE BEACH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 MISSION AVE
OCEANSIDE CA
92057-6541
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-7439
  • Fax:
Mailing address:
  • Phone: 858-554-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: