Provider Demographics
NPI:1154071447
Name:BECKMAN, JESSICA JOAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOAN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17411 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1809
Mailing Address - Country:US
Mailing Address - Phone:714-864-0649
Mailing Address - Fax:
Practice Address - Street 1:47474 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8846
Practice Address - Country:US
Practice Address - Phone:626-479-8383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty