Individual provider · NPI-1

Mary Beny Becerril-Gonzalez, MS, LAT, ATC

Specialist/Technologist, Athletic Trainer · Minneapolis, MN

NPI number1659911204
StatusActive
Last updated in NPPESDec 13, 2021

Details

NPI
1659911204
Entity type
Individual (NPI-1)
Name
Mary Beny Becerril-Gonzalez
Credential
MS, LAT, ATC
Sex
Female
Sole proprietor
No
Enumeration date
Jan 12, 2020
Certification date
Dec 13, 2021
Last updated
Dec 13, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer3401MNYes
2255A2300X Specialist/Technologist, Athletic Trainer––
390200000X Student in an Organized Health Care Education/Training Program–MN

Practice location

2211 Riverside Ave
Minneapolis, MN 55454-1350

Phone 612-330-1008

Mailing address

15430 Founders Ln Apt 234
Apple Valley, MN 55124-6182

Phone 952-380-6196

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