Provider Demographics
NPI:1982844080
Name:BEAVANS MEDICAL, INC.
Entity Type:Organization
Organization Name:BEAVANS MEDICAL, INC.
Other - Org Name:BEAVANS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZENAIDA
Authorized Official - Middle Name:NICOLAS
Authorized Official - Last Name:BEAVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-281-5906
Mailing Address - Street 1:8835 E CLOUDVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1679
Mailing Address - Country:US
Mailing Address - Phone:714-281-5906
Mailing Address - Fax:
Practice Address - Street 1:8835 E CLOUDVIEW WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1679
Practice Address - Country:US
Practice Address - Phone:714-281-5906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAVANS MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-02
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUS2001-03402332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6443830001Medicare NSC