Healthcare Provider Details

I. General information

NPI: 1912579137
Provider Name (Legal Business Name): MS. ELIZABETH LOUISE BECKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9822 ARAPAHO ST
SPRING VALLEY CA
91977-5203
US

IV. Provider business mailing address

9822 ARAPAHO ST
SPRING VALLEY CA
91977-5203
US

V. Phone/Fax

Practice location:
  • Phone: 619-987-9948
  • Fax:
Mailing address:
  • Phone: 619-987-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: