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NPI Code Detail

MEDICARE: MS. RENNA SHORT BECERRA M.D.

MEDICARE: MS. RENNA SHORT BECERRA M.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine PhysicianTL.0004253CO
3207R00000XInternal Medicine PhysicianDR.0055631CO

General Provider Information

NPI Number : 1831464189
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RENNA SHORT BECERRA M.D.
Provider Business Mailing Address
First Line : 2695 ROCKY MOUNTAIN AVE
Second Line : SUITE150
City : LOVELAND
State : CO
Zip : 80538-8702
Country : US
Telephone Number : 970-624-4443
Fax Number :
Provider Business Practice Location Address
First Line : 4050 BRIARGATE PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-7815
Country : US
Telephone Number : 719-365-1292
Fax Number : 719-365-6997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2012
Last Update Date : 09/10/2015

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