# BEAVER MEDICAL GROUP P C

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BEAVER MEDICAL GROUP P C
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609110667
- **Legal business name:** BEAVER MEDICAL GROUP P C
- **Authorized official:** EMILY CASTILLO (ASSOCIATE DIRECTOR)
- **Authorized official phone:** (702) 480-2550

## Contact information

- **Practice address:** 81 SOUTH HIGHLAND SPRINGS AVENUE, SUITE 101 & 200, BEAUMONT, CA 92223-3170
- **Practice address phone:** (951) 845-0313
- **Practice address fax:** (951) 849-3225
- **Mailing address:** PO BOX 35380, LAS VEGAS, NV 89133-5380
- **Mailing address phone:** (702) 480-2550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 07/24/2024