MEDICARE: BEACH FAMILY DOCTORS MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	363A00000X	Physician Assistant
3	363LF0000X	Family Nurse Practitioner
4	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1538110465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH FAMILY DOCTORS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 15775
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92659-5775
Country	:	US
Telephone Number	:	657-241-3600
Fax Number	:	657-241-7708

Provider Business Practice Location Address
First Line	:	2001 WESTCLIFF DR STE 200
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5552
Country	:	US
Telephone Number	:	714-845-5900
Fax Number	:	714-845-5920

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JULIA HARRIS
Credential	:	MD
Telephone Number	:	714-845-5900

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	11/24/2020

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