=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861553380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICAELA BECERRA FELIX D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 01/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23374 W. YUMA RD SUITE 101
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-374-7833
-----------------------------------------------------
Fax | 623-594-0114
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23374 W. YUMA RD SUITE 101
-----------------------------------------------------
City | BUCKEYE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-374-7833
-----------------------------------------------------
Fax | 623-594-0114
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 20A10034
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 4770
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------