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NPI Code Detail

MEDICARE: MS. AZALEA ANN BECERRA M.F.T.

MEDICARE: MS. AZALEA ANN BECERRA M.F.T.
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
1106H00000XMarriage & Family TherapistMFC41089CA

General Provider Information

NPI Number : 1750410098
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AZALEA ANN BECERRA M.F.T.
Provider Business Mailing Address
First Line : 205 PASADENA AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2919
Country : US
Telephone Number : 323-219-0117
Fax Number :
Provider Business Practice Location Address
First Line : 205 PASADENA AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2919
Country : US
Telephone Number : 323-622-0724
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/04/2007
Last Update Date : 05/06/2015

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