Healthcare Provider Details

I. General information

NPI: 1992814602
Provider Name (Legal Business Name): STEVEN M BEUTLER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRACINA BLVD
REDLANDS CA
92373-4850
US

IV. Provider business mailing address

PO BOX 2095
RANCHO CUCAMONGA CA
91729-2095
US

V. Phone/Fax

Practice location:
  • Phone: 951-738-0968
  • Fax: 951-738-0524
Mailing address:
  • Phone: 951-738-0968
  • Fax: 951-738-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG69216
License Number StateCA

VIII. Authorized Official

Name: MS. KIMBERLY DIANE SWANSON
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 951-738-0968