Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | VN120314 | CA |
NPI | 1346388642 |
---|---|
Provider Name | Mary Beasley |
First Address | San Francisco, CA 94110-4092 |
Second Address | San Francisco, CA 94110-4092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |