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NPI Code Detail

MEDICARE: JAMES M BEAULIEU

MEDICARE: JAMES M BEAULIEU
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1174025738
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES M BEAULIEU
Provider Business Mailing Address
First Line : 830 SUNSET DR APT I
Second Line :
City : PACIFIC GROVE
State : CA
Zip : 93950-4729
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1178 BROADWAY AVE
Second Line :
City : SEASIDE
State : CA
Zip : 93955-4934
Country : US
Telephone Number : 831-394-4622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2018
Last Update Date : 02/28/2018

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