Healthcare Provider Details

I. General information

NPI: 1467362905
Provider Name (Legal Business Name): DORA M BEASTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 CHALLENGER WAY
SANTA ROSA CA
95407-5418
US

IV. Provider business mailing address

34674 AVENUE 14
MADERA CA
93636-7900
US

V. Phone/Fax

Practice location:
  • Phone: 707-569-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number428814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: