DR. BEVERLY R HENDRICKSON (NPI# 1306910906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306910906 |
| Entity Type | Individual |
| Full Name | DR. BEVERLY R HENDRICKSON |
| Credential | MD |
| Practice Address |
30230 Rancho Viejo Rd Suite A San Juan Capistrano CA 92675 |
| Practice Telephone | 9494937337 |
| Practice Fax Number | 9493731300 |
| Mailing Telephone | 9494937337 |
| Mailing Fax Number | 9493731300 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | G40908 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0081160 | 05 |
| Street Address |
30230 RANCHO VIEJO RD SUITE A |
| City | SAN JUAN CAPISTRANO |
| State | CA |
| Zip Code | 92675 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982655304 | Patricia Ann Ahearn | Specialist | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2006-05-12 |
| 1033501077 | Pacific Private Practice Network Inc | Family Medicine | 30230 Rancho Viejo Rd, Suite 110, San Juan Capistrano, CA 92675-1557 | 2015-02-27 |
| 1679816680 | Karen Jean Caruso | Nurse Practitioner | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2013-03-28 |
| 1801129663 | Sanjivan Singh Kohli | Internal Medicine | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2009-09-11 |
| 1124250022 | Prajan Subedi | Internal Medicine | 30230 Rancho Viejo Rd, 200, San Juan Capistrano, CA 92675-1557 | 2009-08-12 |
| 1871785220 | Bryan O King | Internal Medicine | 30230 Rancho Viejo Rd, Ste 200, San Juan Capistrano, CA 92675-1557 | 2007-08-09 |
| 1447330915 | Rahul Madhav Kale | Internal Medicine | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2006-10-17 |
| 1457431504 | William Gustin | Hospitalist | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2006-10-16 |
| 1346331725 | Paloma Medical Group Inc | Specialist | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2006-09-28 |
| 1417902149 | William Weiming Chang | Specialist | 30230 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675-1557 | 2006-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184268088 | Dana Caballero | Social Worker | 30240 Racho Viejo Rd, Suite C-1, San Juan Capistrano, CA 92675 | 2019-11-04 |
| 1801363858 | Hgrt Medical Group Inc | Internal Medicine | 31741 Rancho Hill Viejo Road, San Juan Capistrano, CA 92675 | 2018-10-29 |
| 1487132551 | Alex James Vanderschelden | Chiropractor | 36461 Rancho Viejo Rd. Suiete 103, Suite 103, San Juan Capistrano, CA 92675 | 2018-08-01 |
| 1295224780 | Gateway Healthcare, Inc. | Skilled Nursing Facility | 29222 Rancho Viejo Rd Ste 127, San Juan Capistrano, CA 92675 | 2018-05-09 |
| 1033606991 | Pelican Point Dental | Dentist | 31103 Rancho Viejo Road Ste D2444, San Juan Capistrano, CA 92675 | 2018-04-17 |
| 1639677511 | Ocean Hills Recovery Inc. | Substance Abuse Rehabilitation Facility | 27126b Paseo Espada, Suite 725, San Juan Capistrano, CA 92675 | 2018-01-25 |
| 1679091441 | D Dawn Maxwell | Counselor | 30950 Rancho Viejo Rd Suite 225, San Juan Capistrano, CA 92675 | 2017-08-31 |
| 1417491523 | Terry D'amico | Physical Therapy Assistant | 32961 Calle Miguel, San Juan Capistrano, CA 92675 | 2016-12-08 |
| 1235580556 | Marriage Made Better Relationship Counseling | Community/Behavioral Health | 30200 Rancho Viejo Road, Suite D, San Juan Capistrano, CA 92675 | 2016-06-28 |
| 1679923288 | Shanti Recovery Services, Inc. | Community Based Residential Treatment Facility, Mental Illness | 31211 Casa Grande Drive, San Juan Capistrano, CA 92675 | 2016-06-14 |
| Find all providers in zip 92675 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073662912 | Jon Conti | Pediatrics | 30210 Rancho Viejo Rd Ste A, San Juan Capistrano, CA 92675-1574 | 2007-01-09 |
| 1841389814 | Ashraf Gamil Fahim | Pediatrics | 32221 Camino Capistrano, Suite B103, San Juan Capistrano, CA 92675-3721 | 2006-10-11 |
| 1003171604 | Cristina Carolina Romero De Montero | Pediatrics | 30300 Camino Capistrano, San Juan Capistrano, CA 92675-1304 | 2012-07-10 |
| 1073793790 | San Juan Pediatrics Inc | Pediatrics | 32221 Camino Capistrano, Suite B-103, San Juan Capistrano, CA 92675-3721 | 2007-11-09 |
| 1427175900 | Lydia A Chapelsky | Pediatrics | 30210 Rancho Viejo Rd, Suite A, San Juan Capistrano, CA 92675-1574 | 2007-03-22 |
| 1346337821 | John H Carruth | Pediatrics | 30210 Rancho Viejo Rd, Suite A, San Juan Capistrano, CA 92675 | 2006-10-06 |
| 1972697233 | Charles Martin Strom | Pediatrics | 33608 Ortega Hwy, San Juan Capistrano, CA 92690 | 2006-10-03 |
| 1528151669 | Delbert Arthur Fisher | Pediatrics | 33608 Ortega Highway, Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92690 | 2006-10-02 |
| 1104808161 | Eric J Wong | Pediatrics | 30300 Rancho Viejo Rd, San Juan Capistrano, CA 92675-1576 | 2005-11-16 |
| 1801877170 | Trung Truong | Pediatrics | 31001 Rancho Viejo Rd, Suite 200, San Juan Capistrano, CA 92675 | 2005-11-14 |
| Find all providers in SAN JUAN CAPISTRANO | ||||
| City | SAN JUAN CAPISTRANO |
| Zip Code | 92675 |
Please comment or provide details below to improve the information on DR. BEVERLY R HENDRICKSON.
| 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.