Provider Demographics
NPI:1669550885
Name:BEATON, ROBERTO ANGEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANGEL
Last Name:BEATON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 W VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1334
Mailing Address - Country:US
Mailing Address - Phone:818-843-6611
Mailing Address - Fax:818-843-6656
Practice Address - Street 1:4314 W VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1334
Practice Address - Country:US
Practice Address - Phone:818-843-6611
Practice Address - Fax:818-843-6656
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G452440Medicaid
CAG45244OtherCA STATE LICENSE NUMBER
CAB57549Medicare UPIN
CA00G452440Medicaid