Provider Demographics
NPI:1083993984
Name:AARON S BEAN DPM INC
Entity Type:Organization
Organization Name:AARON S BEAN DPM INC
Other - Org Name:WEST COAST FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:760-565-5545
Mailing Address - Street 1:79405 HIGHWAY 111
Mailing Address - Street 2:SUITE 9-469
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8300
Mailing Address - Country:US
Mailing Address - Phone:760-574-1904
Mailing Address - Fax:760-424-5578
Practice Address - Street 1:79200 CORPORATE CENTER DR STE 104
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7245
Practice Address - Country:US
Practice Address - Phone:760-565-5545
Practice Address - Fax:760-424-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4951213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245568476Medicaid