Provider Demographics
NPI:1801588181
Name:BEAUMONTE, KATHERINE (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:BEAUMONTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 INGLEWOOD AVENUE
Mailing Address - Street 2:BLDG 101, SUITE 126
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278
Mailing Address - Country:US
Mailing Address - Phone:310-867-8744
Mailing Address - Fax:
Practice Address - Street 1:4001 INGLEWOOD AVENUE
Practice Address - Street 2:BLDG 101, SUITE 126
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278
Practice Address - Country:US
Practice Address - Phone:310-867-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health