Provider Demographics
NPI:1083644710
Name:BECKER, OLGA V (MD)
Entity type:Individual
Prefix:DR
First Name:OLGA
Middle Name:V
Last Name:BECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11779 ALDERHILL TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3865
Mailing Address - Country:US
Mailing Address - Phone:619-543-6252
Mailing Address - Fax:619-543-5732
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8620
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-2728
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA726142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A726140Medicaid
CAWA72614AMedicare ID - Type Unspecified
CA00A726140Medicaid