| NPI | 1881857597 |
|---|---|
| Doing Business As | BEAVER MEDICAL GROUP - BANNING EXTENDED CARE |
| 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 C51632) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2013-04-25 |