Individual
MS. LUANN SUE BEACOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4060 4TH AVE, SUITE 420, SAN DIEGO, CA 92103
(619) 299-3111
(619) 299-3126
Mailing address
5383 BOTHE AVE, SAN DIEGO, CA 92122
(858) 546-9088
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9876
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
249
CLIN. NURSE SPEC CERT #
CA
01
—
9876
N.P. FURNISHING #
CA
01
—
RN336125
R.N. LICENSE #
CA
Enumeration date
10/05/2006
Last updated
03/07/2023
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