Provider Demographics
NPI:1780232850
Name:ELIZABETH C. BEAL, D.O., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELIZABETH C. BEAL, D.O., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:OPEN MINDED OSTEOPATHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CLAUDIA HOPKIRK
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:510-529-5825
Mailing Address - Street 1:200 S MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9366
Mailing Address - Country:US
Mailing Address - Phone:805-670-2180
Mailing Address - Fax:805-273-0298
Practice Address - Street 1:200 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9366
Practice Address - Country:US
Practice Address - Phone:805-670-2180
Practice Address - Fax:805-273-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77631OtherKAREO EHR
CA748145OtherANTHEM