Basic Information
Provider Information | |||||||||
NPI: | 1780659797 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BECKER | ||||||||
FirstName: | REHANA | ||||||||
MiddleName: | PARVEEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AHMED | ||||||||
OtherFirstName: | REHANA | ||||||||
OtherMiddleName: | PARVEEN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 12221 N MOPAC EXPY | ||||||||
Address2: |   | ||||||||
City: | AUSTIN | ||||||||
State: | TX | ||||||||
PostalCode: | 787582401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5129014009 | ||||||||
FaxNumber: | 5129013992 | ||||||||
Practice Location | |||||||||
Address1: | 1250 S CAPITAL OF TEXAS HWY FL 1 | ||||||||
Address2: |   | ||||||||
City: | WEST LAKE HILLS | ||||||||
State: | TX | ||||||||
PostalCode: | 787466446 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5123342403 | ||||||||
FaxNumber: | 5123342493 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/22/2006 | ||||||||
LastUpdateDate: | 01/26/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | K9964 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 144512100 | 01 |   | FIRST CARE | OTHER | 84055X | 01 |   | BCBS | OTHER | 047257301 | 05 | TX |   | MEDICAID | 047257303 | 05 | TX |   | MEDICAID | P00988779 | 01 | TX | RRMDCR | OTHER |