Provider Demographics
NPI:1215272448
Name:BEAVER MEDICAL GROUP P C
Entity type:Organization
Organization Name:BEAVER MEDICAL GROUP P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-2550
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-480-2550
Mailing Address - Fax:
Practice Address - Street 1:245 TERRACINA BLVD.
Practice Address - Street 2:STE. 102
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4865
Practice Address - Country:US
Practice Address - Phone:909-792-2605
Practice Address - Fax:909-307-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies