Provider Demographics
NPI:1447822325
Name:BECERRA, SOFIA INES (DC)
Entity type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:INES
Last Name:BECERRA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 SAN MARINO BLVD APT 103
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7717
Mailing Address - Country:US
Mailing Address - Phone:787-633-7969
Mailing Address - Fax:
Practice Address - Street 1:10233 OKEECHOBEE BLVD STE B6
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1407
Practice Address - Country:US
Practice Address - Phone:561-753-2225
Practice Address - Fax:561-296-0378
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor