Provider Demographics
NPI:1730126608
Name:BEEMANS BOUTIQUE LLC
Entity Type:Organization
Organization Name:BEEMANS BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MICHELL
Authorized Official - Last Name:BEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-882-0193
Mailing Address - Street 1:355 E 21ST ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4851
Mailing Address - Country:US
Mailing Address - Phone:909-882-0193
Mailing Address - Fax:909-883-4834
Practice Address - Street 1:355 E 21ST ST
Practice Address - Street 2:SUITE J
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4851
Practice Address - Country:US
Practice Address - Phone:909-882-0193
Practice Address - Fax:909-883-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4712280001Medicare ID - Type Unspecified