Provider Demographics
NPI:1538282090
Name:BECERRA, IZA N (MACCSLP)
Entity Type:Individual
Prefix:
First Name:IZA
Middle Name:N
Last Name:BECERRA
Suffix:
Gender:F
Credentials:MACCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 S CLOSNER BLVD
Mailing Address - Street 2:STE F1
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5718
Mailing Address - Country:US
Mailing Address - Phone:956-387-0939
Mailing Address - Fax:956-387-0954
Practice Address - Street 1:1615 S CLOSNER BLVD
Practice Address - Street 2:STE F1
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5718
Practice Address - Country:US
Practice Address - Phone:956-387-0939
Practice Address - Fax:956-387-0954
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87665TOtherBCBS INDV NUMBER