Healthcare Provider Details

I. General information

NPI: 1710561279
Provider Name (Legal Business Name): MAURA LETECIA BECERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD BLDG 400 3RD FLOOR
SALINAS CA
93906
US

IV. Provider business mailing address

1441 CONSTITUTION BLVD BLDG 400 3RD FLOOR
SA CA
93906
US

V. Phone/Fax

Practice location:
  • Phone: 831-755-4123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: