Provider Demographics
NPI:1427894930
Name:FATEHIMANESH, BEETA (FNP)
Entity type:Individual
Prefix:
First Name:BEETA
Middle Name:
Last Name:FATEHIMANESH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 LA FIESTA
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-4008
Mailing Address - Country:US
Mailing Address - Phone:714-488-4680
Mailing Address - Fax:
Practice Address - Street 1:5161 CALIFORNIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92617-8002
Practice Address - Country:US
Practice Address - Phone:866-300-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily