Provider Demographics
NPI:1710584008
Name:BECK, VENESSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 CARDIFF ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-5019
Mailing Address - Country:US
Mailing Address - Phone:619-465-3121
Mailing Address - Fax:619-465-6708
Practice Address - Street 1:903 CARDIFF ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-5019
Practice Address - Country:US
Practice Address - Phone:619-465-3121
Practice Address - Fax:619-465-6708
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015282363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA31235212Medicaid