Provider Demographics
NPI:1699852632
Name:BECERRA, MERARDO ANTONIO (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MERARDO
Middle Name:ANTONIO
Last Name:BECERRA
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND
Mailing Address - Street 2:TORRES DEL PARQUE, APT. 1402 SUR
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3070
Mailing Address - Country:US
Mailing Address - Phone:787-787-7838
Mailing Address - Fax:
Practice Address - Street 1:1700 CALLE FEDERICO MONTILLA S
Practice Address - Street 2:APT. 1402 SUR
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3065
Practice Address - Country:US
Practice Address - Phone:787-787-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16,300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics