Healthcare Provider Details

I. General information

NPI: 1861553380
Provider Name (Legal Business Name): MICAELA BECERRA FELIX D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICAELA BECERRA POWELL D.O.

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23374 W. YUMA RD SUITE 101
BUCKEYE AZ
85326
US

IV. Provider business mailing address

23374 W. YUMA RD SUITE 101
BUCKEYE AZ
85326
US

V. Phone/Fax

Practice location:
  • Phone: 623-374-7833
  • Fax: 623-594-0114
Mailing address:
  • Phone: 623-374-7833
  • Fax: 623-594-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A10034
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4770
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: