Provider Demographics
NPI:1497789499
Name:BECKLEY, OLAWUNMI A (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAWUNMI
Middle Name:A
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:2700 GRANT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2266
Practice Address - Country:US
Practice Address - Phone:925-674-2500
Practice Address - Fax:925-674-2503
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69200207Q00000X, 207QS0010X
PAMD071455L207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A692000Medicaid
CAP00358321OtherRAILROAD MEDICARE
CAH46712Medicare UPIN
CA00A692000Medicaid