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General NPI Number Information
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NPI Number | 1487416616
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Entity Type | Individual
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Provider Name | JONATHAN L BECERRA LOPEZ DC
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Gender | Male
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Dates
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Enumeration Date | 01/24/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 40 CALLE FLORENCIO SANTIAGO
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City | COAMO
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State | PR
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Zip | 00769-3208
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Country | US
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Telephone | 787-648-1863
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Fax |
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Provider Business Mailing Address
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Address Line | EXT JARD DE COAMO CALLE 13 F2
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City | COAMO
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State | PR
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Zip | 00769
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Country | US
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Telephone | 787-648-1863
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4913
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License Number State | SC
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