1477546059 NPI number — DIANA GUERRERO BETANCOURT MD

Table of content: DIANA GUERRERO BETANCOURT MD (NPI 1477546059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477546059 NPI number — DIANA GUERRERO BETANCOURT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRERO BETANCOURT
Provider First Name:
DIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477546059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6520 CASTLEBURY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-561-3692
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WILLIAM CARLS DR
Provider Second Line Business Practice Location Address:
HURON VALLEY SINAI HOSPITAL
Provider Business Practice Location Address City Name:
COMMERCE TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-937-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  4301406079 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)