Provider Demographics
NPI:1083501134
Name:BECK, GWENDOLYN L
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:L
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27460 BUENA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7980
Mailing Address - Country:US
Mailing Address - Phone:951-537-7779
Mailing Address - Fax:
Practice Address - Street 1:27460 BUENA VISTA ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7980
Practice Address - Country:US
Practice Address - Phone:951-537-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722832163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse