Healthcare Provider Details

I. General information

NPI: 1306226881
Provider Name (Legal Business Name): THOMAS BEESLEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 PRECISION PARK LN
SAN YSIDRO CA
92173-1346
US

IV. Provider business mailing address

1666 PRECISION PARK LN
SAN YSIDRO CA
92173-1346
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-600-4870
Mailing address:
  • Phone: 619-662-4100
  • Fax: 619-600-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number02005251A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A25629
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number279138
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: