1720079130 NPI number — DR. CYNTHIA MAXINE BECK MD

Table of content: DR. CYNTHIA MAXINE BECK MD (NPI 1720079130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720079130 NPI number — DR. CYNTHIA MAXINE BECK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECK
Provider First Name:
CYNTHIA
Provider Middle Name:
MAXINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BECK-ALAVAZO
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
MAXINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720079130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14901 RINALDI ST
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
MISSION HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-365-8553
Provider Business Mailing Address Fax Number:
818-242-8761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14901 RINALDI ST
Provider Second Line Business Practice Location Address:
#200
Provider Business Practice Location Address City Name:
MISSION HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-365-8553
Provider Business Practice Location Address Fax Number:
818-838-9279
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  A65996 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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