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General NPI Number Information
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NPI Number | 1770112476
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Entity Type | Individual
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Provider Name | CLARA MILUSKA CASTILLEJO BECERRA MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2020
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 1408 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8279
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Country | US
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Telephone | 541-779-2020
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Fax | 541-770-6838
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Provider Business Mailing Address
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Address Line | 1408 E BARNETT RD
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City | MEDFORD
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State | OR
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Zip | 97504-8279
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Country | US
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Telephone | 541-779-2020
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Fax | 541-770-6838
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 69555
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30751
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD219074
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License Number State | OR
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