Provider Demographics
NPI:1023248036
Name:BECERRA, CHRISTINA M (RDN, LD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:M
Last Name:BECERRA
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 COLONEL VANDERHORST CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8036
Mailing Address - Country:US
Mailing Address - Phone:913-952-5404
Mailing Address - Fax:
Practice Address - Street 1:711 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-3235
Practice Address - Country:US
Practice Address - Phone:913-684-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL0088767133V00000X
SC1049133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
130592Medicare UPIN