Healthcare Provider Details

I. General information

NPI: 1083501134
Provider Name (Legal Business Name): GWENDOLYN L BECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 W OLYMPIC BLVD STE 780
LOS ANGELES CA
90064-1829
US

IV. Provider business mailing address

27460 BUENA VISTA ST
HEMET CA
92543-7980
US

V. Phone/Fax

Practice location:
  • Phone: 213-721-1571
  • Fax:
Mailing address:
  • Phone: 951-537-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number722832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: