Provider Demographics
NPI:1639497050
Name:BEALS INJURY CENTER INC
Entity Type:Organization
Organization Name:BEALS INJURY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-405-8199
Mailing Address - Street 1:4061 BONITA BEACH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4073
Mailing Address - Country:US
Mailing Address - Phone:239-405-8199
Mailing Address - Fax:239-405-8197
Practice Address - Street 1:5274 GOLDEN GATE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7641
Practice Address - Country:US
Practice Address - Phone:239-405-8199
Practice Address - Fax:239-405-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG524101712691OtherDRIVER LICENSE