MEDICARE: RAYMOND BEATY

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	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1174471452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYMOND BEATY

Provider Business Mailing Address
First Line	:	848 CAMERON CT
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-7303
Country	:	US
Telephone Number	:	707-637-6582
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 ALLISON CT STE 2B
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-3063
Country	:	US
Telephone Number	:	707-205-1603
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ RAYMOND BEATY ” Practice Location

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