| Doctor Name: | NICHOLAS ROBERT BEATTY |
| NPI Number: | 1295927747 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | PA14337 |
| Business Practice Address: | 22182 Barton Rd Grand Terrace, CA - 923135033 |
| Business Phone Number: | 9094220422 |
| Business Fax Number: | |
| Mailing Address: | 22182 Barton Rd, GRAND TERRACE |
| State: | CA |
| Postal Code: | 923135033 |
| Phone Number: | 9094220422 |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2007 |
| NPI Last Update Date: | 08/17/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA14337 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |