| Organization Name: | BEACON MEDICAL MANAGEMENT LLC |
| NPI Number: | 1902166085 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER JEANNE MILAM (OWNER) |
| Mailing Address: | 13372 Newport Ave Ste I Tustin |
| State: | CA US |
| Postal Code: | 927803426 |
| Phone Number: | 7147319355 |
| Fax Number: | 7147319350 |
| NPI Enumeration Date: | 05/22/2012 |
| NPI Last Update Date: | 05/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |