Provider Demographics
NPI:1669523387
Name:BECK, JENNIFER PAULA (MD)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PAULA
Last Name:BECK
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 1:1400 N DUTTON AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4657
Mailing Address - Country:US
Mailing Address - Phone:707-566-4600
Mailing Address - Fax:707-566-4644
Practice Address - Street 1:1400 N DUTTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4657
Practice Address - Country:US
Practice Address - Phone:707-566-4600
Practice Address - Fax:707-566-4644
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG787182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA59-3812356OtherEIN NUMBER
CAG13021Medicare UPIN
00G787180Medicare ID - Type Unspecified