1255402657 NPI number — DR. LAURENCE DAVID BECKER PH.D.

Table of content: DR. LAURENCE DAVID BECKER PH.D. (NPI 1255402657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255402657 NPI number — DR. LAURENCE DAVID BECKER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKER
Provider First Name:
LAURENCE
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1255402657
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5319 UNIVERSITY DR
Provider Second Line Business Mailing Address:
PMB 226
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-2965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-833-1268
Provider Business Mailing Address Fax Number:
949-854-1843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CORPORATE PARK
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92606-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-833-1268
Provider Business Practice Location Address Fax Number:
949-854-1843
Provider Enumeration Date:
11/10/2006

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: 103TC2200X , with the licence number:  PSY 5491 , 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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