Provider Demographics
NPI:1437324019
Name:BECKER, MARILYN JOYCE (PA)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:JOYCE
Last Name:BECKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 LYNN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1901
Mailing Address - Country:US
Mailing Address - Phone:805-495-1066
Mailing Address - Fax:805-497-0162
Practice Address - Street 1:2230 LYNN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1901
Practice Address - Country:US
Practice Address - Phone:805-495-1066
Practice Address - Fax:805-497-0162
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 10124363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical