Healthcare Provider Details

I. General information

NPI: 1346398286
Provider Name (Legal Business Name): GAY M BESETH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 N 13TH AVE SUITE 204
UPLAND CA
91786-4965
US

IV. Provider business mailing address

510 N 13TH AVE SUITE 204
UPLAND CA
91786-4965
US

V. Phone/Fax

Practice location:
  • Phone: 909-920-0525
  • Fax: 909-920-0526
Mailing address:
  • Phone: 909-920-0525
  • Fax: 909-920-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP10839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: