Provider Demographics
NPI:1669928701
Name:BEANATO, JORGE
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:BEANATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-2426
Mailing Address - Country:US
Mailing Address - Phone:562-437-6717
Mailing Address - Fax:
Practice Address - Street 1:1891 N GAFFEY ST
Practice Address - Street 2:SUITE 228
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-1267
Practice Address - Country:US
Practice Address - Phone:310-514-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program