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General NPI Number Information
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NPI Number | 1407121999
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Entity Type | Individual
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Provider Name | JORGE ARTURO BECERRA CAS
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Gender | Male
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 790 E. BONITA
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City | POMONA
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State | CA
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Zip | 91723
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Country | US
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Telephone | 626-254-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4424 SO. CENTINELA AVE. 102
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City | LOS ANGELES
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State | CA
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Zip | 90066
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Country | US
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Telephone | 310-487-3536
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 01-109311
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License Number State | CA
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