MEDICARE: JACQUELINE BECERRA-LISING RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	21913	CA
2	174400000X	Specialist		CA

General Provider Information

NPI Number	:	1215694955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BECERRA-LISING RDH

Provider Business Mailing Address
First Line	:	13925 CITY CENTER DR STE 200
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5438
Country	:	US
Telephone Number	:	909-702-6745
Fax Number	:

Provider Business Practice Location Address
First Line	:	13925 CITY CENTER DR STE 200
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-5438
Country	:	US
Telephone Number	:	909-702-6745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	05/26/2025

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