Provider Demographics
NPI:1417660986
Name:BECERRA, DANIELA (BS)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:BECERRA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50680 CHIAPAS DR
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-5417
Mailing Address - Country:US
Mailing Address - Phone:760-989-2203
Mailing Address - Fax:
Practice Address - Street 1:50680 CHIAPAS DR
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-5417
Practice Address - Country:US
Practice Address - Phone:760-989-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXEIT50443772OtherBLUE SHIELD OF CALIFORNIA