Healthcare Provider Details

I. General information

NPI: 1861429664
Provider Name (Legal Business Name): MARC BECKER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 E SANTA ANA CANYON RD SUITE 130
ANAHEIM HILLS CA
92807-3737
US

IV. Provider business mailing address

5241 E SANTA ANA CANYON RD SUITE 130
ANAHEIM HILLS CA
92807-3737
US

V. Phone/Fax

Practice location:
  • Phone: 714-637-0800
  • Fax:
Mailing address:
  • Phone: 714-637-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: