Provider Demographics
NPI:1760586986
Name:BECERRA, ENRIQUE HERNANDEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:HERNANDEZ
Last Name:BECERRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY
Mailing Address - Street 2:STE 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:956-794-8787
Practice Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY
Practice Address - Street 2:STE 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:956-794-8787
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6987207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151374901Medicaid
E90844Medicare UPIN
TX8F20913Medicare PIN