Provider Demographics
NPI:1649550062
Name:BECK, ELLEN L (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:UCSD MEDICAL GROUP
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:619-543-3500
Mailing Address - Fax:
Practice Address - Street 1:200 WEST ARBOR DR - MC 8201
Practice Address - Street 2:UCSD MEDICAL GROUP
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:619-543-1899
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG61838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G618380Medicaid
CAWG61838AMedicare PIN