Provider Demographics
NPI:1780295089
Name:BEAM, AUTUMN (MS, ACN)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BEAM
Suffix:
Gender:F
Credentials:MS, ACN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 N LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2140
Mailing Address - Country:US
Mailing Address - Phone:626-664-9719
Mailing Address - Fax:
Practice Address - Street 1:1437 N LOS ROBLES AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2140
Practice Address - Country:US
Practice Address - Phone:626-664-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education