Provider Demographics
NPI:1770057499
Name:BECERRA ARTEAGA, AGUSTIN ENRIQUE (SA-C)
Entity type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:ENRIQUE
Last Name:BECERRA ARTEAGA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 NORTHPOINTE BLVD APT 8201
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2290
Mailing Address - Country:US
Mailing Address - Phone:901-494-8688
Mailing Address - Fax:
Practice Address - Street 1:12101 NORTHPOINTE BLVD APT 8201
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-2290
Practice Address - Country:US
Practice Address - Phone:901-494-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14-656246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant