Healthcare Provider Details

I. General information

NPI: 1497789499
Provider Name (Legal Business Name): OLAWUNMI A. BECKLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 GRANT ST SUITE 110
CONCORD CA
94520-2266
US

IV. Provider business mailing address

DEPT 34929 P.O. BOX 39000
SAN FRANCISCO CA
94139-0001
US

V. Phone/Fax

Practice location:
  • Phone: 925-674-2500
  • Fax: 925-674-2503
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69200
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA69200
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD071455L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD071455L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: