Provider Demographics
NPI:1558178731
Name:BECERRA ORTEGA, SADIE
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:BECERRA ORTEGA
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 1:731 GRAND AVE LOT 135
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80651-7602
Mailing Address - Country:US
Mailing Address - Phone:720-986-2474
Mailing Address - Fax:
Practice Address - Street 1:731 GRAND AVE LOT 135
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:CO
Practice Address - Zip Code:80651-7602
Practice Address - Country:US
Practice Address - Phone:720-986-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter