1518926435 NPI number — BROM D BECKERMAN M.D.

Table of content: BROM D BECKERMAN M.D. (NPI 1518926435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518926435 NPI number — BROM D BECKERMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKERMAN
Provider First Name:
BROM
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518926435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39000 BOB HOPE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-3221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-346-0642
Provider Business Mailing Address Fax Number:
760-340-9152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39000 BOB HOPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-3221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-346-0642
Provider Business Practice Location Address Fax Number:
760-340-9152
Provider Enumeration Date:
03/20/2006

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: 207RC0000X , with the licence number:  A43660 , 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)

  • Identifier: 00A436600 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".