Healthcare Provider Details

I. General information

NPI: 1710398086
Provider Name (Legal Business Name): MATTHEW JAMES BEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARDY AVE
SAN DIEGO CA
92115
US

IV. Provider business mailing address

5700 HARDY AVE
SAN DIEGO CA
92115
US

V. Phone/Fax

Practice location:
  • Phone: 619-594-4325
  • Fax: 619-594-6465
Mailing address:
  • Phone: 619-594-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC186888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: