Provider Information for 1992103170
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RANDOLPH BEASLEY
Sex: Male
NPI: 1992103170
Last Updated: 2024-09-23
Certification Date: 2024-09-23
Certification Date: 2024-09-23
Details
| Name | Value | ||||||||||||||||
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| NPI | 1992103170 | ||||||||||||||||
| Enumeration Date | 2014-12-20 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 12200 LINCOLNSHIRE DR BAKERSFIELD, CA 93311-9582 United States Phone: 530-522-8489 | Fax: | ||||||||||||||||
| Primary Practice Address | 12200 LINCOLNSHIRE DR BAKERSFIELD, CA 93311-9582 United States Phone: 530-522-8489 | Fax: | ||||||||||||||||
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