Provider Demographics
NPI:1922488824
Name:BECKETTI, NICHOLAS CANE (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CANE
Last Name:BECKETTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 AMERICANA WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91210-1507
Mailing Address - Country:US
Mailing Address - Phone:415-349-0850
Mailing Address - Fax:415-354-3430
Practice Address - Street 1:759 AMERICANA WAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91210-1507
Practice Address - Country:US
Practice Address - Phone:415-349-0850
Practice Address - Fax:415-354-3430
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine