Provider Demographics
NPI:1821011339
Name:BECKLES, DEDRA AYANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEDRA
Middle Name:AYANNA
Last Name:BECKLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DEDRA
Other - Middle Name:AYANNA
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR DEDRA MARSHALL
Mailing Address - Street 1:2600 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2325
Mailing Address - Country:US
Mailing Address - Phone:562-988-7469
Mailing Address - Fax:
Practice Address - Street 1:2600 REDONDO AVE
Practice Address - Street 2:302
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2325
Practice Address - Country:US
Practice Address - Phone:562-988-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine