MEDICARE: MINA BEATTIE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1215759469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA BEATTIE

Provider Business Mailing Address
First Line	:	1 UNIVERSITY DR
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92866-1005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W CHAPMAN AVE STE 122
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2648
Country	:	US
Telephone Number	:	949-989-6932
Fax Number	:

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

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	10/29/2024

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Directions to “ MINA BEATTIE ” Practice Location

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