MEDICARE: DR. VANCE B BECKER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY007654	CA

General Provider Information

NPI Number	:	1013912443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANCE B BECKER PH.D.

Provider Business Mailing Address
First Line	:	1451 QUAIL ST
Second Line	:	STE 102
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2747
Country	:	US
Telephone Number	:	949-757-1113
Fax Number	:	949-757-1114

Provider Business Practice Location Address
First Line	:	1451 QUAIL ST
Second Line	:	STE 102
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2747
Country	:	US
Telephone Number	:	949-757-1113
Fax Number	:	949-757-1114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	08/04/2010

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