Provider Demographics
NPI:1790029759
Name:BEAVER MEDICAL GROUP P C
Entity type:Organization
Organization Name:BEAVER MEDICAL GROUP P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-480-2550
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:1690 BARTON ROAD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4231
Practice Address - Country:US
Practice Address - Phone:909-793-3311
Practice Address - Fax:909-335-4111
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAVER MEDICAL GROUP P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-15
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies