Provider Demographics
NPI:1184718587
Name:BEACHCARDIOLOGYMED.GROUP INC.,
Entity type:Organization
Organization Name:BEACHCARDIOLOGYMED.GROUP INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TSS
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:714-839-2122
Mailing Address - Street 1:15581 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7554
Mailing Address - Country:US
Mailing Address - Phone:714-839-2122
Mailing Address - Fax:
Practice Address - Street 1:15581 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7554
Practice Address - Country:US
Practice Address - Phone:714-839-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26101207PE0004X, 207RC0000X
207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW 5483AMedicare ID - Type Unspecified
CAW 5483Medicare ID - Type Unspecified