Provider Demographics
NPI:1104873033
Name:BECK, WALTER DICK
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:DICK
Last Name:BECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 BOLSA AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1146
Mailing Address - Country:US
Mailing Address - Phone:714-898-5732
Mailing Address - Fax:714-901-4058
Practice Address - Street 1:10929 SOUTH ST
Practice Address - Street 2:STE 202B
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5340
Practice Address - Country:US
Practice Address - Phone:562-860-1504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1794237600000X
CAHA4147237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0017940Medicaid