Provider Demographics
NPI:1710561279
Name:BECERRA, MAURA LETECIA
Entity Type:Individual
Prefix:
First Name:MAURA LETECIA
Middle Name:
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 1:1441 CONSTITUTION BLVD
Mailing Address - Street 2:BLDG 400 3RD FLOOR
Mailing Address - City:SA
Mailing Address - State:CA
Mailing Address - Zip Code:93906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1441 CONSTITUTION BLVD
Practice Address - Street 2:BLDG 400 3RD FLOOR
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906
Practice Address - Country:US
Practice Address - Phone:831-755-4123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine