BEAVER MEDICAL GROUP LP (NPI# 1205013323) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205013323 |
| Entity Type | Organization |
| Organization Name | BEAVER MEDICAL GROUP LP |
| Practice Address |
33758 Yucaipa Blvd Yucaipa CA 92399-2243 |
| Mailing Address |
P.o. Box 2200 Redlands CA 92373-0722 |
| Practice Telephone | 9097959747 |
| Practice Fax Number | 9097954663 |
| Mailing Telephone | 9097931818 |
| Mailing Fax Number | 9097964158 |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2012-11-09 |
| NPI Deactivation Date | 09/10/2009 |
| NPI Reactivation Date | 2012-11-09 |
| Authorized Official Name | DENNIS PATRICK FLYNN (VICE PRESIDENT OF MEDICAL AFFAIRS) |
| Authorized Official Telephone | 9097991818 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | Eye and Vision Services Providers | ||
| N | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207W00000X | Ophthalmology | Allopathic & Osteopathic Physicians | ||
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629482641 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 81 Highland Springs Ave, Suite 200, Beaumont, CA 92223-3170 | 2014-06-18 |
| 1578991816 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 2 W Fern Ave, Suite 200, Redlands, CA 92373-5916 | 2013-10-24 |
| 1881857597 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 6109 W Ramsey St, Banning, CA 92220-3051 | 2008-07-03 |
| 1639344716 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 7000 Boulder Ave, Highland, CA 92346-3348 | 2008-04-29 |
| 1831377662 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2008-02-04 |
| Street Address |
33758 YUCAIPA BLVD |
| City | YUCAIPA |
| State | CA |
| Zip Code | 92399-2243 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295701977 | Victor Salib | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2006-02-23 |
| 1629681614 | Keely Alison Niemeyer | Dietitian, Registered | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2020-08-28 |
| 1750894630 | Huong Le | Optometrist | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2017-11-14 |
| 1801338645 | Kaitlin Darlene Kostecki | Nurse Practitioner | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2016-11-10 |
| 1568844645 | Lisa Shelly-ann Thompson | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2015-06-24 |
| 1457730392 | Mina Sameh Sobhy Soliman | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2015-05-26 |
| 1427437813 | Rachael Suzanne Tennant | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2015-05-19 |
| 1891188454 | Marina Gonzalez | Physician Assistant | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2015-03-06 |
| 1295047058 | Mi La Kim | Nurse Practitioner | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2010-07-09 |
| 1740500313 | Marc Hualong Ma | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2010-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891301941 | Emily Ambrosi | Occupational Therapist | 12257 Tulip Ln, Yucaipa, CA 92399 | 2020-09-23 |
| 1952943524 | Terrence Williams | Behavioral Analyst | 13768 Meadow View Lane, Yucaipa, CA 92399 | 2019-10-15 |
| 1235795097 | Han Acu&herbs, Inc | Acupuncturist | 32387 Yucaipa Blvd, Ste, F, Yucaipa, CA 92399 | 2019-05-16 |
| 1366926784 | David Gene Satre | Psychologist | 31752 Dove Ct, Yucaipa, CA 92399 | 2018-09-21 |
| 1336659861 | Titianna Little | Physical Therapist | 32819 Yucaipa Boulevard #3, Yucaipa, CA 92399 | 2017-10-11 |
| 1174043467 | Sharon Lee Pendola | Licensed Vocational Nurse | 11885 4th St, Yucaipa, CA 92399 | 2017-06-27 |
| 1073033072 | Juniper Manor, LLC | Skilled Nursing Facility | 35223 Juniper Avenue, Yucaipa, CA 92399 | 2017-06-21 |
| 1952858417 | Rafael Arias | Non-emergency Medical Transport (VAN) | 12386 17th St, Yucaipa, CA 92399 | 2016-09-01 |
| 1578906467 | Joyce I Bandele | Durable Medical Equipment & Medical Supplies | 34664 County Line Rd Suite 14, Yucaipa, CA 92399 | 2013-04-10 |
| 1033475108 | Loleta Michelle Gustafson | Marriage & Family Therapist | 34455 Yucaipa Blvd Ste 206, Yucaipa, CA 92399 | 2012-04-03 |
| Find all providers in zip 92399 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467527762 | Pranav Raghuvir Mehta | Family Medicine | 12047 4th St, Yucaipa, CA 92399-2735 | 2006-11-21 |
| 1245344126 | Khwaja Ali Siddiqui | Family Medicine | 34845 Yucaipa Blvd, Ste A, Yucaipa, CA 92399 | 2006-08-18 |
| 1295701977 | Victor Salib | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2006-02-23 |
| 1568844645 | Lisa Shelly-ann Thompson | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2015-06-24 |
| 1457730392 | Mina Sameh Sobhy Soliman | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2015-05-26 |
| 1427437813 | Rachael Suzanne Tennant | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2015-05-19 |
| 1740500313 | Marc Hualong Ma | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399 | 2010-06-07 |
| 1689993313 | Maher Danhash | Family Medicine | 34845 Yucaipa Blvd, Suite A, Yucaipa, CA 92399-4268 | 2010-05-20 |
| 1013186923 | Tonya Ann Yoney | Family Medicine | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2008-02-25 |
| 1962681270 | Pranav R. Mehta, M.d., Inc. | Family Medicine | 12047 4th St, Yucaipa, CA 92399-2735 | 2007-11-02 |
| Find all providers in YUCAIPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.