Healthcare Provider Details

I. General information

NPI: 1265424683
Provider Name (Legal Business Name): BRENT RICHARD BECKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL CAMP PENDLETON BLDG H 100, SANTA MARGARTIA RD.
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

SANTA MARGARTIA RD BLDG H 100,NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1400
  • Fax: 760-725-1101
Mailing address:
  • Phone: 760-725-1400
  • Fax: 760-725-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A 8511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: