Provider Demographics
NPI:1598880106
Name:DR ENRIQUE H. BECERRA P.A.
Entity Type:Organization
Organization Name:DR ENRIQUE H. BECERRA P.A.
Other - Org Name:ENRIQUE H. BECERRA, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:9567-948-7984
Mailing Address - Street 1:4151 LOOP 20
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4725
Mailing Address - Country:US
Mailing Address - Phone:956-794-8784
Mailing Address - Fax:
Practice Address - Street 1:4151 LOOP 20
Practice Address - Street 2:SUITE 203
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4725
Practice Address - Country:US
Practice Address - Phone:956-794-8784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6987207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151374901Medicaid
TX151374901Medicaid
TXE90844Medicare UPIN