Provider Demographics
NPI:1255579462
Name:BECERRA, VICTOR (SONOGRAPHER)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:BECERRA
Suffix:
Gender:M
Credentials:SONOGRAPHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 SENECA LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3139
Mailing Address - Country:US
Mailing Address - Phone:702-325-8074
Mailing Address - Fax:702-796-1593
Practice Address - Street 1:1593 SENECA LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3139
Practice Address - Country:US
Practice Address - Phone:702-325-8074
Practice Address - Fax:702-796-1593
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1701251519246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography