Provider Demographics
NPI:1184817850
Name:BECERRA, ROSALINA
Entity type:Individual
Prefix:
First Name:ROSALINA
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:PO BOX 401724
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92340-1724
Mailing Address - Country:US
Mailing Address - Phone:442-284-0588
Mailing Address - Fax:442-267-4365
Practice Address - Street 1:14420 CIVIC DR
Practice Address - Street 2:STE 6
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2384
Practice Address - Country:US
Practice Address - Phone:442-284-0588
Practice Address - Fax:442-267-4365
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW21089101YM0800X
CALCSW638991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health