Healthcare Provider Details

I. General information

NPI: 1275634511
Provider Name (Legal Business Name): TIFFANY MERRILL BECKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 DEEP VALLEY DR SUITE 201
ROLLING HILLS ESTATES CA
90274-3647
US

IV. Provider business mailing address

56 BUCKSKIN LN
ROLLING HILLS ESTATES CA
90274-4205
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-5400
  • Fax: 310-541-5466
Mailing address:
  • Phone: 310-325-3233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA067392
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: