1457689416 NPI number — JEANNINE MARIE BEAUMONT MFT, ATR

Table of content: JEANNINE MARIE BEAUMONT MFT, ATR (NPI 1457689416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457689416 NPI number — JEANNINE MARIE BEAUMONT MFT, ATR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAUMONT
Provider First Name:
JEANNINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT, ATR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEAUMONT
Provider Other First Name:
JEANNIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT, ATR
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457689416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDONDO BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90277-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-543-9377
Provider Business Mailing Address Fax Number:
310-543-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1926 S PACIFIC COAST HWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
REDONDO BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90277-6119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-543-9377
Provider Business Practice Location Address Fax Number:
310-543-9308
Provider Enumeration Date:
12/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 47817 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)