Most Relevant Information
Provider Data
| NPI Number: | 1003273590 |
| Provider Name: | PATTY BEAVER LSW |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 11742 |
Most Important Dates
| Enumeration Date: | 01/28/2016 |
| Last Updated: | 10/20/2022 |
Provider Practice Location
11201 BENTON ST
LOMA LINDA
CA
923575703
Practice Location Phone/Fax
| Phone: | 9096742794 |
| Fax: |
Provider Mailing Location
11201 BENTON ST
LOMA LINDA
CA
923571000
Provider Mailing Phone/Fax
| Phone: | 9096742794 |
| Fax: |