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General NPI Number Information
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NPI Number | 1174916779
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Entity Type | Organization
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Legal Business Name | BEACHKIDS PEDIATRICS A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 918 EMERALD ST
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3261
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Country | US
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Telephone | 310-697-6833
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Fax | 848-210-9648
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Provider Business Mailing Address
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Address Line | 918 EMERALD ST
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3261
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Country | US
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Telephone | 310-697-6833
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Fax | 848-210-9648
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | MRS. THERESA CANGIALOSI
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Credential | NP
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Telephone | 310-697-6833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 9281
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License Number State | CA
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