Provider Demographics
NPI:1063177756
Name:BECASEN, JOSHUA (MPH, RD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BECASEN
Suffix:
Gender:M
Credentials:MPH, RD
Other - Prefix:
Other - First Name:JOSH
Other - Middle Name:LOU
Other - Last Name:SEGUNDO BECASEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MPH, RD
Mailing Address - Street 1:4850 S WHITE MOUNTAIN RD APT A-6
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7854
Mailing Address - Country:US
Mailing Address - Phone:619-947-1175
Mailing Address - Fax:
Practice Address - Street 1:200 WEST HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941
Practice Address - Country:US
Practice Address - Phone:928-338-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09427133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered