Healthcare Provider Details

I. General information

NPI: 1295516938
Provider Name (Legal Business Name): BEAMING HEALTHCARE GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 FILLMORE ST # 1367
SAN FRANCISCO CA
94115-2708
US

IV. Provider business mailing address

484 HILLVIEW DR
FREMONT CA
94536-2821
US

V. Phone/Fax

Practice location:
  • Phone: 415-236-2178
  • Fax:
Mailing address:
  • Phone: 510-701-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DOMENIQUE CAROL HENDERSHOT EMBREY
Title or Position: OWNER
Credential: OTD, MS OTR/L
Phone: 510-701-5990