Provider Demographics
NPI:1720583560
Name:BEACH, SHIRE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SHIRE
Middle Name:LYNN
Last Name:BEACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCLA MEDICINE EDUCATION OFFICE, RRUCLA MEDICAL CENTER
Mailing Address - Street 2:757 WESTWOOD PLAZA, SUITE 7501
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UCLA MEDICINE EDUCATION OFFICE, RRUCLA MEDICAL CENTER
Practice Address - Street 2:757 WESTWOOD PLAZA, SUITE 7501
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program