| NPI | 1831377662 |
|---|---|
| Doing Business As | BEAVER MEDICAL GROUP - COOLEY RANCH |
| Entity Type | Organization |
| Authorized Contact | KENNY HEINE VP Of Operations 858-625-2990 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA G58149) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2013-04-25 |