Organization
BEAVER MEDICAL GROUP P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY CASTILLO (ASSOCIATE DIRECTOR)
(702) 480-2550
Entity
Organization
Contact information
Practice address
7000 BOULDER AVE, HIGHLAND, CA 92346-3348
(909) 862-1191
(909) 796-4158
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 480-2550
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
231H00000X
Audiologist
—
—
Other
Enumeration date
06/10/2006
Last updated
08/20/2024
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