Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner |
NPI | 1790324408 |
---|---|
Provider Name | Armando Becerra |
First Address | Stockton, CA 95202-1552 |
Second Address | Stockton, CA 95202-1552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2019 |
Last Update Date | 27/12/2019 |