# BEAVER MEDICAL GROUP P C

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BEAVER MEDICAL GROUP - PRIMARY CARE NORTH
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528312089
- **Authorized official:** EMILY CASTILLO (ASSOCIATE DIRECTOR)
- **Authorized official phone:** (702) 450-2550

## Contact information

- **Practice address:** 2 W FERN AVE, REDLANDS, CA 92373-5916
- **Practice address phone:** (909) 793-3311
- **Mailing address:** PO BOX 35380, LAS VEGAS, NV 89133-5380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | G58102 | CA | Yes |

## Other

- **Enumeration date:** 11/06/2012
- **Last updated:** 09/26/2025