Basic Information
| Provider Information | |||||||||
| NPI: | 1548740970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECERRA-RODRIGUEZ | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | KAREN | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 841 W LA HABRA BLVD APT I101 | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906319042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622425826 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4000 W METROPOLITAN DR STE 405 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146458000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2018 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 107712 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.