Provider Demographics
NPI:1538972187
Name:BECERRA, ANTHONY JOE (LMT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOE
Last Name:BECERRA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9393 E PALO BREA BND APT 3008
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6516
Mailing Address - Country:US
Mailing Address - Phone:602-317-6381
Mailing Address - Fax:
Practice Address - Street 1:9393 E PALO BREA BND APT 3008
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6516
Practice Address - Country:US
Practice Address - Phone:602-317-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-25380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist