Basic Information
| Provider Information | |||||||||
| NPI: | 1831464189 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECERRA | ||||||||
| FirstName: | RENNA | ||||||||
| MiddleName: | SHORT | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2695 ROCKY MOUNTAIN AVE | ||||||||
| Address2: | SUITE150 | ||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805388702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706244443 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4050 BRIARGATE PKWY | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809207815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193651292 | ||||||||
| FaxNumber: | 7193656997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 09/10/2015 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | TL.0004253 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | DR.0055631 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.