Provider Demographics
NPI:1679533780
Name:BEA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:BEA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, CFO, PRESIDENT, & FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-746-0300
Mailing Address - Street 1:10070 PASADENA AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5942
Mailing Address - Country:US
Mailing Address - Phone:408-746-0300
Mailing Address - Fax:
Practice Address - Street 1:10070 PASADENA AVE
Practice Address - Street 2:STE 2
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5942
Practice Address - Country:US
Practice Address - Phone:408-746-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 34120207QA0505X, 207QA0505X
CACLM 311477261QP2300X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04099ZMedicare PIN