=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740314392
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA CLAIRE BECKS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16111 PLUMMER ST
-----------------------------------------------------
City | SEPULVEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91343-2036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-895-5810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3161 GLENCREST DR
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91208-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-957-5045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 14288
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------