Provider Demographics
NPI:1306078068
Name:LALLANDE, BEVERLY JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JEAN
Last Name:LALLANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12662
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5070
Mailing Address - Country:US
Mailing Address - Phone:562-427-2006
Mailing Address - Fax:562-989-0573
Practice Address - Street 1:4300 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2011
Practice Address - Country:US
Practice Address - Phone:562-427-2006
Practice Address - Fax:562-989-0573
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM81102084P0800X
CAA1130392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry