Organization
BEAVER MEDICAL GROUP P C
Active
Other names
Optum Banner Specialty Care
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY CASTILLO (ASSOCIATE DIRECTOR)
(702) 480-2550
Entity
Organization
Contact information
Practice address
6109 W RAMSEY ST, BANNING, CA 92220-3051
(951) 845-0313
(909) 796-4158
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3209
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RX0202X
Medical Oncology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
06/02/2006
Last updated
04/14/2025
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