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Individual

MRS. DIANDRA CORAL BECENTI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
2300 E 30TH ST BLDG D, SUITE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 564-3202
Mailing address
2300 E 30TH ST BLDG D, SUITE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 564-3202

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2009-0009
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
15375862
NM
01
202037772
PHP
01
9592385
AETNA
01
PA2009-0009
NM LICENSE
NM
Enumeration date
06/03/2009
Last updated
04/01/2010
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