Provider Demographics
NPI:1124460381
Name:BECERRA, RICARDO
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:BECERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 TURTLEROCK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1236
Mailing Address - Country:US
Mailing Address - Phone:702-630-9682
Mailing Address - Fax:
Practice Address - Street 1:3216 W CHARLESTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2044
Practice Address - Country:US
Practice Address - Phone:702-544-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst