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NPI Code Detail

MEDICARE: DR. BEVANNE A BEAN-MAYBERRY MD

MEDICARE: DR. BEVANNE A BEAN-MAYBERRY MD
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
1207R00000XInternal Medicine PhysicianC52366CA
2207R00000XInternal Medicine PhysicianMD 068860-LPA

General Provider Information

NPI Number : 1528163888
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BEVANNE A BEAN-MAYBERRY MD
Provider Business Mailing Address
First Line : 14745 VALLEYHEART DR
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91403-1601
Country : US
Telephone Number : 818-895-9449
Fax Number :
Provider Business Practice Location Address
First Line : 16111 PLUMMER ST
Second Line : VA GREATER LOS ANGELES - SEPULVEDA
City : SEPULVEDA
State : CA
Zip : 91343-2036
Country : US
Telephone Number : 818-895-9449
Fax Number : 818-895-5838
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 07/08/2007

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