OrganizationActive
Beaver Medical Group Lp
NPI 1578991816 · Non-Pharmacy Dispensing Site · Redlands, CA
Provider details
- NPI number
- 1578991816
- Entity type
- Organization
- Primary specialty
- Non-Pharmacy Dispensing SiteSuppliers
- Parent organization
- Medvantx, Inc.
- Organization subpart
- Yes
- Authorized official
- Kenny Heine, Vp of Operations(858) 964-1506
- License
- A96734 (CA)
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(77/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2 W Fern Ave
Suite 200
Redlands, CA 92373-5916
Phone: (909) 793-3311
Street-level locationGet directions
Mailing address
5626 Oberlin Dr
San Diego, CA 92121-1705
Other names (DBA / former)
- Doing business as
- Beaver Medical Group - Internal
Registry dates
- Enumerated
- 2013-10-24
- Last updated
- 2013-10-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.