Provider Demographics
NPI:1699462176
Name:BECARIA, SHIRLEY YVONNE
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:YVONNE
Last Name:BECARIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 W 148TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3356
Mailing Address - Country:US
Mailing Address - Phone:424-205-7669
Mailing Address - Fax:
Practice Address - Street 1:1813 W 148TH ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-3356
Practice Address - Country:US
Practice Address - Phone:310-347-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3668994172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver