NPI 1689174146 · live from the CMS NPI Registry
Evan Jae Beale, PA-C
Physician Assistant in San Diego, CA. National Provider Identifier 1689174146, active.
NPI record
| NPI | 1689174146 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 9339 Genesee Ave Ste 350a, San Diego, CA 92121 |
| Practice phone | 858-263-0571 |
| Mailing address | 2285 Corporate Cir, Ste 200, Henderson, NV 89074 |
| Enumerated | February 20, 2018 |
| Last updated | March 11, 2019 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 7083 (AZ) |
| Physician Assistant primary | 363A00000X | 55344 (CA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.