Individual
JACKELYN TANIOS BESHIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2001 SANTA MONICA BLVD STE 1070, SANTA MONICA, CA 90404-2202
(310) 917-3376
(310) 582-6302
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A156540
CA
Other
Enumeration date
06/02/2014
Last updated
09/19/2019
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