Provider Demographics
NPI:1679698229
Name:TIRKANITS, BEATRIX (MD, FCSRC)
Entity Type:Individual
Prefix:
First Name:BEATRIX
Middle Name:
Last Name:TIRKANITS
Suffix:
Gender:F
Credentials:MD, FCSRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7721
Mailing Address - Country:US
Mailing Address - Phone:949-721-0494
Mailing Address - Fax:949-721-4138
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-721-0494
Practice Address - Fax:949-721-4138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist