Provider Demographics
NPI:1487707212
Name:LO, BETH (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1501 WESTCLIFF DR STE 225
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5541
Mailing Address - Country:US
Mailing Address - Phone:949-999-2945
Mailing Address - Fax:828-372-4525
Practice Address - Street 1:1501 WESTCLIFF DR STE 225
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5541
Practice Address - Country:US
Practice Address - Phone:949-999-2945
Practice Address - Fax:828-372-4525
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA865642084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86564OtherCA MEDICAL LICENSE
CABL8774122OtherDEA
CABL8774122OtherDEA