Healthcare Provider Details

I. General information

NPI: 1376584433
Provider Name (Legal Business Name): BRUCE B BECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5363 BALBOA BLVD SUITE 246
ENCINO CA
91316-2805
US

IV. Provider business mailing address

5363 BALBOA BLVD STE 246
ENCINO CA
91316-2805
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-3510
  • Fax: 818-783-9059
Mailing address:
  • Phone: 818-783-3510
  • Fax: 818-783-9059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC40316
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC40316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: