Healthcare Provider Details

I. General information

NPI: 1730611310
Provider Name (Legal Business Name): PATRICK LIAM BEAGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 JEFFERSON LN NE
ALBUQUERQUE NM
87109-2127
US

IV. Provider business mailing address

4150 V ST # 1200
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7900
  • Fax: 505-727-9590
Mailing address:
  • Phone: 916-734-5028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD2024-0713
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: