MEDICARE: ROBERTO ANGEL BEATON M.D.

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	207R00000X	Internal Medicine Physician	G45244	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	G45244	OTHER	CA	CA STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1669550885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO ANGEL BEATON M.D.

Provider Business Mailing Address
First Line	:	4314 W VICTORY BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1334
Country	:	US
Telephone Number	:	818-843-6611
Fax Number	:	818-843-6656

Provider Business Practice Location Address
First Line	:	4314 W VICTORY BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-1334
Country	:	US
Telephone Number	:	818-843-6611
Fax Number	:	818-843-6656

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/09/2007

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