Individual
MR. BRUCE EDWARD BECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PPS,LEP
Contact information
Practice address
1305 E VINE ST, LODI, CA 95240-3179
(209) 915-2753
Mailing address
1305 E VINE ST, LODI, CA 95240-3179
(209) 915-2753
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
2529
CA
Other
Enumeration date
08/16/2024
Last updated
08/16/2024
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