Healthcare Provider Details

I. General information

NPI: 1902155997
Provider Name (Legal Business Name): LUIS ANTONIO BECERRA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MACARTHUR BLVD
NEWPORT BEACH CA
92660-2558
US

IV. Provider business mailing address

PO BOX 755
TUSTIN CA
92781-0755
US

V. Phone/Fax

Practice location:
  • Phone: 949-793-0122
  • Fax:
Mailing address:
  • Phone: 714-415-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: