Provider Demographics
NPI:1710045836
Name:SCOTT A. BEASLEY, M.D., INC.
Entity Type:Organization
Organization Name:SCOTT A. BEASLEY, M.D., INC.
Other - Org Name:CALIFORNIA NEONATOLOGY SERVICES MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-492-3514
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92674-1359
Mailing Address - Country:US
Mailing Address - Phone:949-492-3514
Mailing Address - Fax:949-366-2390
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-5716
Practice Address - Fax:949-366-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057610Medicaid