Provider Demographics
NPI:1467953018
Name:BECKER, RICHARD D (MS, ATC, CSCS, CES)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:BECKER
Suffix:
Gender:M
Credentials:MS, ATC, CSCS, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FALLON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4808
Mailing Address - Country:US
Mailing Address - Phone:510-464-3580
Mailing Address - Fax:
Practice Address - Street 1:900 FALLON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4808
Practice Address - Country:US
Practice Address - Phone:925-464-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000189972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer