Provider Demographics
NPI:1346520483
Name:GORDON, BECCA (CLD, CCE)
Entity Type:Individual
Prefix:
First Name:BECCA
Middle Name:
Last Name:GORDON
Suffix:
Gender:F
Credentials:CLD, CCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3949 LOS FELIZ BLVD
Mailing Address - Street 2:#202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2348
Mailing Address - Country:US
Mailing Address - Phone:901-219-1262
Mailing Address - Fax:
Practice Address - Street 1:3949 LOS FELIZ BLVD
Practice Address - Street 2:#202
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2348
Practice Address - Country:US
Practice Address - Phone:901-219-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-21
Last Update Date:2011-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula