Healthcare Provider Details

I. General information

NPI: 1477515435
Provider Name (Legal Business Name): HOPE ANITA BECKLUND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 PETALUMA AVE SUITE F
SEBASTOPOL CA
95472-4256
US

IV. Provider business mailing address

652 PETALUMA AVE SUITE F
SEBASTOPOL CA
95472-4256
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-2334
  • Fax: 707-823-3007
Mailing address:
  • Phone: 707-823-2334
  • Fax: 707-823-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA60274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: