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General NPI Number Information
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NPI Number | 1144265919
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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 | 06/17/2006
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 1300 E COOLEY DR
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City | COLTON
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State | CA
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Zip | 92324-3905
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Country | US
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Telephone | 909-370-4100
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Fax | 909-796-4158
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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