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General NPI Number Information
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NPI Number | 1124460381
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Entity Type | Individual
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Provider Name | RICARDO BECERRA
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Gender | Male
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 3216 W CHARLESTON BLVD SUITE A
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City | LAS VEGAS
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State | NV
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Zip | 89102-2044
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Country | US
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Telephone | 702-544-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 1921 TURTLEROCK ST
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City | LAS VEGAS
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State | NV
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Zip | 89142-1236
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Country | US
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Telephone | 702-630-9682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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