Provider Demographics
NPI:1790441012
Name:BEALL, CHRISTIAN MATTHEW
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:MATTHEW
Last Name:BEALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 SUNRISE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4144
Mailing Address - Country:US
Mailing Address - Phone:530-470-2409
Mailing Address - Fax:
Practice Address - Street 1:406 SUNRISE AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4144
Practice Address - Country:US
Practice Address - Phone:530-470-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB7378614OtherDRIVERS LICENSE