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Organization

BEAVER MEDICAL GROUP P C

Active
Other names
OPTUM
Organization subpart
No

Provider details

NPI number
Authorized official
EMILY CASTILLO (ASSOCIATE DIRECTOR)
(702) 480-2550
Entity
Organization

Contact information

Practice address
2 WEST FERN AVENUE, REDLANDS, CA 92373-5916
(909) 793-3311
(909) 335-1936
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 480-2550

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
207N00000X
Dermatology Physician
207Q00000X
Family Medicine Physician
Primary
207R00000X
Internal Medicine Physician
207RG0100X
Gastroenterology Physician
207RH0003X
Hematology & Oncology Physician
207RR0500X
Rheumatology Physician
207V00000X
Obstetrics & Gynecology Physician
207W00000X
Ophthalmology Physician
207X00000X
Orthopaedic Surgery Physician
208000000X
Pediatrics Physician
2084N0400X
Neurology Physician
2085R0202X
Diagnostic Radiology Physician
208600000X
Surgery Physician
208800000X
Urology Physician

Other

Enumeration date
09/14/2009
Last updated
08/20/2024
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