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General NPI Number Information
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NPI Number | 1063045656
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Entity Type | Organization
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Legal Business Name | BEAVER MEDICAL GROUP P C
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 839 HIGHLAND SPRINGS PARKWAY BUILDING C
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City | BEAUMONT
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State | CA
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Zip | 92223
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Country | US
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Telephone | 951-845-0313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-480-2550
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | EMILY CASTILLO
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Credential |
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Telephone | 702-480-2550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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