Provider Demographics
NPI:1578943478
Name:BECKETTI, PEGGY C (DO)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:C
Last Name:BECKETTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:C
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 E CHAPEL ST
Mailing Address - Street 2:STE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4619
Mailing Address - Country:US
Mailing Address - Phone:805-739-3561
Mailing Address - Fax:
Practice Address - Street 1:1400 E CHURCH ST
Practice Address - Street 2:BUILDING 8
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5906
Practice Address - Country:US
Practice Address - Phone:805-739-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty