MEDICARE: DR. JOHN PAUL BEAUDOIN M.DIV.,PH.D.,Q.M.E.

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	103TC0700X	Clinical Psychologist	PSY13842	CA
2	103TF0200X	Forensic Psychologist	935452	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY13842	OTHER	CA	PSYCHOLOGY LIC.
2	935452	OTHER	CA	QUAILIFIED MEDICAL EXAMIN
3	OPL138420	OTHER	CA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1467424721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PAUL BEAUDOIN M.DIV.,PH.D.,Q.M.E.

Provider Business Mailing Address
First Line	:	PO BOX 746
Second Line	:
City	:	PEBBLE BEACH
State	:	CA
Zip	:	93953-0746
Country	:	US
Telephone Number	:	831-648-0845
Fax Number	:	831-665-5351

Provider Business Practice Location Address
First Line	:	PO BOX 746
Second Line	:
City	:	PEBBLE BEACH
State	:	CA
Zip	:	93953-0746
Country	:	US
Telephone Number	:	831-648-0845
Fax Number	:	831-665-5351

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	04/07/2026

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