1053445403 NPI number — NICOLAS R BETANCOURT M.D.

Table of content: NICOLAS R BETANCOURT M.D. (NPI 1053445403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053445403 NPI number — NICOLAS R BETANCOURT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETANCOURT
Provider First Name:
NICOLAS
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1053445403
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TORRE DE AUXILIO MUTUO 735 PONCE DE LEON
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-767-0655
Provider Business Mailing Address Fax Number:
787-767-0655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE DE AUXILIO MUTUO 735 PONCE DE LEON
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-767-0555
Provider Business Practice Location Address Fax Number:
787-767-0655
Provider Enumeration Date:
03/16/2007

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:  7226 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 066410 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0400034 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 8537 . This is a "IMC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 29460 . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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