Healthcare Provider Details

I. General information

NPI: 1356983217
Provider Name (Legal Business Name): BRIAN EDWARD BEASLEY JD, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CAMINO DEL REMEDIO BLDG 3
SANTA BARBARA CA
93110-1332
US

IV. Provider business mailing address

PO BOX 5519
SANTA BARBARA CA
93150-5519
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-5220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: