Healthcare Provider Details

I. General information

NPI: 1124936422
Provider Name (Legal Business Name): ROBERT WILLIAM BECKNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38397 INNOVATION CT STE 103
MURRIETA CA
92563-2631
US

IV. Provider business mailing address

1150 N KIRBY ST SPC 152
HEMET CA
92545-1397
US

V. Phone/Fax

Practice location:
  • Phone: 833-428-7827
  • Fax:
Mailing address:
  • Phone: 909-681-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number86719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: