Provider Demographics
NPI:1467469965
Name:BECKER, WARREN (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 ROYALTY DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3030
Mailing Address - Country:US
Mailing Address - Phone:909-620-8180
Mailing Address - Fax:909-469-6741
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:SUITE 220
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-620-8180
Practice Address - Fax:909-469-6741
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG312132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G312130Medicaid
CACG1263OtherRAILROAD MEDICARE
CA00G312130Medicaid
CA00G312135Medicare PIN
CA00G312139Medicare PIN
CA00G312134Medicare PIN
CACG1263OtherRAILROAD MEDICARE
CA00G312138Medicare PIN
CA00G312132Medicare PIN
CA00G312133Medicare PIN