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General NPI Number Information
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NPI Number | 1093048365
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Entity Type | Organization
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Legal Business Name | BRUCE B BECKER MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 5363 BALBOA BLVD 246
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City | ENCINO
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State | CA
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Zip | 91316-2805
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Country | US
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Telephone | 818-783-3510
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Fax | 818-783-9053
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Provider Business Mailing Address
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Address Line | 5363 BALBOA BLVD 246
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City | ENCINO
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State | CA
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Zip | 91316-2805
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Country | US
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Telephone | 818-783-3510
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Fax | 818-783-9053
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE B BECKER
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Credential | M.D.
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Telephone | 818-783-3510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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