Provider Demographics
NPI:1306144837
Name:BEAUTIFUL MINDS MEDICAL, INC.
Entity type:Organization
Organization Name:BEAUTIFUL MINDS MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BINUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-583-3596
Mailing Address - Street 1:13300 NEW AIRPORT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-7407
Mailing Address - Country:US
Mailing Address - Phone:530-889-8780
Mailing Address - Fax:530-889-8781
Practice Address - Street 1:13300 NEW AIRPORT RD STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-7407
Practice Address - Country:US
Practice Address - Phone:530-889-8780
Practice Address - Fax:530-889-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
CAA1007102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty