Healthcare Provider Details

I. General information

NPI: 1699852632
Provider Name (Legal Business Name): MERARDO ANTONIO BECERRA MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALLE FEDERICO MONTILLA S APT. 1402 SUR
BAYAMON PR
00956-3065
US

IV. Provider business mailing address

COND TORRES DEL PARQUE, APT. 1402 SUR
BAYAMON PR
00956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-7838
  • Fax:
Mailing address:
  • Phone: 787-787-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16,300
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: