Healthcare Provider Details

I. General information

NPI: 1679878565
Provider Name (Legal Business Name): WILLIAM S BEAL DPM PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 LUTHER ST
RIVERSIDE CA
92506-2853
US

IV. Provider business mailing address

4217 LUTHER ST
RIVERSIDE CA
92506
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-2001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE19640
License Number StateCA

VIII. Authorized Official

Name: ANDREW THIO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 951-788-2001