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General NPI Number Information
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NPI Number | 1447861653
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Entity Type | Organization
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Legal Business Name | BEACH PRO PHYSICAL MEDICINE, INC
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 8941 ADAMS AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-3330
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Country | US
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Telephone | 714-962-8818
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Fax | 714-962-8819
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Provider Business Mailing Address
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Address Line | 8941 ADAMS AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-3330
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Country | US
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Telephone | 714-962-8818
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Fax | 714-962-8819
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACQUELYN SAMMONS
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Credential | DO
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Telephone | 714-962-8818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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