Provider Demographics
NPI:1265732648
Name:BECERRA, ANA MILENA (PA-C)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:MILENA
Last Name:BECERRA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S GLENOAKS BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1193
Mailing Address - Country:US
Mailing Address - Phone:818-845-7228
Mailing Address - Fax:818-845-7298
Practice Address - Street 1:303 S GLENOAKS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1193
Practice Address - Country:US
Practice Address - Phone:818-845-7228
Practice Address - Fax:818-845-7298
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11992363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical