Healthcare Provider Details

I. General information

NPI: 1720177157
Provider Name (Legal Business Name): ROBERT K. BECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29738 RANCHO CALIFORNIA RD STE B
TEMECULA CA
92591-5322
US

IV. Provider business mailing address

31588 RAILROAD CANYON RD
CANYON LAKE CA
92587-9468
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6440
  • Fax: 951-303-6449
Mailing address:
  • Phone: 951-471-3888
  • Fax: 951-471-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA45504
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA45504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: