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General NPI Number Information
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NPI Number | 1265930648
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Entity Type | Individual
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Provider Name | CARLA ISABEL BECERRA PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/31/2018
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 333 CEDAR ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3206
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Country | US
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Telephone | 203-785-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 281 RIVER ST APT 1
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4472
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Country | US
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Telephone | 617-899-1722
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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