Provider Demographics
NPI:1851637987
Name:BECERRA, ANGELICA BETH (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:BETH
Last Name:BECERRA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 AVERY RANCH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4600
Mailing Address - Country:US
Mailing Address - Phone:512-255-5252
Mailing Address - Fax:
Practice Address - Street 1:15004 AVERY RANCH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-4600
Practice Address - Country:US
Practice Address - Phone:512-255-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12175111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor