MEDICARE: BEEMAN'S BOUTIQUE LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies		CA

General Provider Information

NPI Number	:	1730126608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEEMAN'S BOUTIQUE LLC

Provider Business Mailing Address
First Line	:	355 E 21ST STREET, SUITE J,
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-882-0193
Fax Number	:	909-883-4834

Provider Business Practice Location Address
First Line	:	355 E 21ST STREET, SUITE J,
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4851
Country	:	US
Telephone Number	:	909-882-0193
Fax Number	:	909-883-4834

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GINA MICHELL BEEMAN
Credential	:
Telephone Number	:	909-882-0193

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/19/2024

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