BEAVER MEDICAL GROUP LP (NPI# 1831377662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1831377662 |
Entity Type | Organization |
Organization Name | BEAVER MEDICAL GROUP LP |
Other Organization Name | BEAVER MEDICAL GROUP - COOLEY RANCH |
Practice Address |
1300 E Cooley Dr Colton CA 92324-3905 |
Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
Practice Telephone | 9092704179 |
Enumeration Date | 2008-02-04 |
Last Update Date | 2013-04-25 |
Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
Authorized Official Telephone | 8586252990 |
Is Organization Subpart | Y |
Parent Organization Name | MEDVANTX, INC. |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 332900000X | Non-Pharmacy Dispensing Site | G58149 | CA | Suppliers |
Other Name | Type Code |
---|---|
Beaver Medical Group - Cooley Ranch | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629482641 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 81 Highland Springs Ave, Suite 200, Beaumont, CA 92223-3170 | 2014-06-18 |
1578991816 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 2 W Fern Ave, Suite 200, Redlands, CA 92373-5916 | 2013-10-24 |
1881857597 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 6109 W Ramsey St, Banning, CA 92220-3051 | 2008-07-03 |
1639344716 | Beaver Medical Group Lp | Non-Pharmacy Dispensing Site | 7000 Boulder Ave, Highland, CA 92346-3348 | 2008-04-29 |
1205013323 | Beaver Medical Group Lp | Optometrist | 33758 Yucaipa Blvd, Yucaipa, CA 92399-2243 | 2008-01-31 |
Street Address |
1300 E COOLEY DR |
City | COLTON |
State | CA |
Zip Code | 92324-3905 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1861447195 | Fay A. Simpson | Nurse Practitioner | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2006-05-24 |
1972052132 | Brenda Jerez-aguilar | Nurse Practitioner | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2016-09-29 |
1497102701 | Hassan Quadri | Family Medicine | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2016-05-17 |
1942654793 | Suchal Karkera | Family Medicine | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2016-04-19 |
1174933279 | Kelvin Ma | Family Medicine | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2014-04-29 |
1497194468 | Linda Kit | Optometrist | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2013-06-22 |
1518212299 | Jennifer Lynn Jensen | Physician Assistant | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2012-07-18 |
1710249461 | Depatment of Behavioral Health | Special Hospital | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2012-06-08 |
1932341203 | Carlos Daniel Ramirez | General Practice | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2009-04-01 |
1730398595 | Nicole Michelle Antonio | Pediatrics | 1300 E Cooley Dr, Colton, CA 92324-3905 | 2007-05-21 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1134739949 | Ava Vascular | Radiology | 1281 W. C. Street, Suite 200, Colton, CA 92324 | 2020-08-06 |
1063042851 | Making A Difference Association, Inc. | Psychologist | 1430 E Cooley Drive, Ste 111, Colton, CA 92324 | 2020-01-21 |
1326685488 | Allstar Medical Respite and Recuperative Care | Case Management | 450 N Sperry Drive, Colton, CA 92324 | 2019-12-06 |
1558916379 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 1010 North Pepper Ave, Colton, CA 92324 | 2019-08-08 |
1326692633 | Kadi Lyn Pearce | Licensed Practical Nurse | 970 N. Latham St, Colton, CA 92324 | 2019-07-25 |
1184281966 | Steven Andrew Cardoza | Physician Assistant | Armc, 400 N. Pepper Ave, Colton, CA 92324 | 2019-05-28 |
1528540952 | Daniel Tochukwu Umah-mgborogwu | Physician Assistant | 400 N Pepper Ave, Ste 107, Coton, CA 92324 | 2018-09-01 |
1255826038 | Cal Med Vascular Center LLC | Clinic/Center | 1281 W C St, Colton, CA 92324 | 2018-06-25 |
1891288072 | A. Arroyo Lourenco Dds, Inc | Dentist | 827 W Valley Blvd., Colton, CA 92324 | 2018-06-12 |
1700396165 | Emily Covington | Registered Nurse | 1550 E. Washington St., Ste 101, Colton, CA 92324 | 2017-10-11 |
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Taxonomy Code | 332900000X |
Grouping | Suppliers |
Classification | Non-Pharmacy Dispensing Site |
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1538546015 | Joseph M Molina Md Professional Corporation Southern California | Non-Pharmacy Dispensing Site | 1181 N Mount Vernon Ave, Colton, CA 92324-2574 | 2015-05-04 |
1396038105 | Andrew W. Hesseltine M.d., Inc | Non-Pharmacy Dispensing Site | 1850 E Washington St, Colton, CA 92324-4621 | 2011-05-26 |
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1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.