MEDICARE: ARIELLE BEAUVOIR ATC, PSYCH ASSOC

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	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1689138455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIELLE BEAUVOIR ATC, PSYCH ASSOC

Provider Business Mailing Address
First Line	:	940 VERNON AVE
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90291-2839
Country	:	US
Telephone Number	:	650-438-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	10323 SANTA MONICA BLVD STE 102
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5056
Country	:	US
Telephone Number	:	424-421-2273
Fax Number	:

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

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	09/24/2024

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