Provider Demographics
NPI:1225057862
Name:BECKER, PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S PASEO DOROTEA
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1434
Mailing Address - Country:US
Mailing Address - Phone:760-320-4431
Mailing Address - Fax:760-416-7236
Practice Address - Street 1:78822 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2046
Practice Address - Country:US
Practice Address - Phone:760-564-7000
Practice Address - Fax:760-328-2191
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A3649208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225057862Medicare PIN