Individual
NICHOLAS ROBERT BEATTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
22182 BARTON RD, GRAND TERRACE, CA 92313-5033
(909) 422-0422
Mailing address
22182 BARTON RD, GRAND TERRACE, CA 92313-5033
(909) 422-0422
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA14337
CA
Other
Enumeration date
08/17/2007
Last updated
08/17/2007
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