Provider Demographics
NPI:1811969371
Name:BECERRA, AMY P (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:P
Last Name:BECERRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4203
Mailing Address - Country:US
Mailing Address - Phone:661-716-2600
Mailing Address - Fax:661-716-2601
Practice Address - Street 1:2005 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4203
Practice Address - Country:US
Practice Address - Phone:661-716-2600
Practice Address - Fax:661-716-2601
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant