MEDICARE: MR. DIEGO BECERRA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	4565	FL
2	332H00000X	Eyewear Supplier	4565	FL

General Provider Information

NPI Number	:	1043471535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DIEGO BECERRA D.O.

Provider Business Mailing Address
First Line	:	5976 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3302
Country	:	US
Telephone Number	:	954-227-2770
Fax Number	:	954-227-7488

Provider Business Practice Location Address
First Line	:	5976 CORAL RIDGE DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-3302
Country	:	US
Telephone Number	:	954-227-2770
Fax Number	:	954-227-7488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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