Basic Information
| Provider Information | |||||||||
| NPI: | 1164615183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECERRIL | ||||||||
| FirstName: | CONSUELO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 266 CORONADO DR | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928792809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513710230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1615 FRENCH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148248150 | ||||||||
| FaxNumber: | 7148248151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | OTA 1490 | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.