Provider Demographics
NPI:1861553380
Name:BECERRA FELIX, MICAELA (DO)
Entity type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:
Last Name:BECERRA FELIX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MICAELA
Other - Middle Name:BECERRA
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:23374 W. YUMA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326
Mailing Address - Country:US
Mailing Address - Phone:623-374-7833
Mailing Address - Fax:623-594-0114
Practice Address - Street 1:23374 W. YUMA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326
Practice Address - Country:US
Practice Address - Phone:623-374-7833
Practice Address - Fax:623-594-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10034208000000X
AZ4770208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ310451Medicaid
OK200068460AMedicaid