Healthcare Provider Details

I. General information

NPI: 1710139241
Provider Name (Legal Business Name): DYSHUN BESHEARS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1222
US

IV. Provider business mailing address

1950 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1222
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-2440
  • Fax:
Mailing address:
  • Phone: 650-573-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DYSHUN EDWARD BESHEARS
Title or Position: MENTAL HEALTH
Credential: M.S.W
Phone: 408-568-5683