Provider Demographics
NPI:1043900277
Name:BECERRA, ANA CARLA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:CARLA
Last Name:BECERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9968 SW 224TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1592
Mailing Address - Country:US
Mailing Address - Phone:786-247-0243
Mailing Address - Fax:
Practice Address - Street 1:9968 SW 224TH ST APT 204
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1592
Practice Address - Country:US
Practice Address - Phone:786-247-0243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-272469106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician