Provider Demographics
NPI:1184846909
Name:JOHN J BECCHETTI MD INC
Entity Type:Organization
Organization Name:JOHN J BECCHETTI MD INC
Other - Org Name:JOHN J BECCHETTI MD
Other - Org Type:Other Name
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BECCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-834-7421
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:STE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-834-7421
Mailing Address - Fax:510-834-7426
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:STE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-834-7421
Practice Address - Fax:510-834-7426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC28615208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C286150Medicaid
CA00C286150Medicaid
CA00C286150Medicare ID - Type Unspecified