MEDICARE: BEAVANS MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	BUS2001-03402	CA

General Provider Information

NPI Number	:	1154561256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVANS MEDICAL, INC.

Provider Business Mailing Address
First Line	:	8835 E CLOUDVIEW WAY
Second Line	:
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-281-5906
Fax Number	:

Provider Business Practice Location Address
First Line	:	8835 E CLOUDVIEW WAY
Second Line	:
City	:	ANAHEIM HILLS
State	:	CA
Zip	:	92808
Country	:	US
Telephone Number	:	714-281-5906
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZENAIDA NICOLAS BEAVANS
Credential	:
Telephone Number	:	714-281-5906

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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