Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | S1562 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | S1562 | TX |
NPI | 1679967640 |
---|---|
Provider Name | Juan Guillermo Becerra |
First Address | El Paso, TX 79912-5919 |
Second Address | El Paso, TX 79902-2924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 26/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400040801 | (05) | TX |