Provider Demographics
NPI:1619991460
Name:MADANI-BECKER, GEULA (MD)
Entity Type:Individual
Prefix:
First Name:GEULA
Middle Name:
Last Name:MADANI-BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S PACIFIC AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3267
Mailing Address - Country:US
Mailing Address - Phone:310-547-9991
Mailing Address - Fax:310-547-2389
Practice Address - Street 1:800 S PACIFIC AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3267
Practice Address - Country:US
Practice Address - Phone:310-547-9991
Practice Address - Fax:310-547-2389
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73277207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0042930Medicaid
CAW1629Medicare PIN
CAH67833Medicare UPIN