Healthcare Provider Details

I. General information

NPI: 1437479334
Provider Name (Legal Business Name): JA'NITA MARCHELE BECERRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

275 BECK AVE
FAIRFIELD CA
94533
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8903
  • Fax:
Mailing address:
  • Phone: 707-784-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number545174
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: