1184835738 NPI number — DR. LUIS FRANCISCO BETANCOURT MD

Table of content: (NPI 1417746033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184835738 NPI number — DR. LUIS FRANCISCO BETANCOURT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BETANCOURT
Provider First Name:
LUIS
Provider Middle Name:
FRANCISCO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1184835738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 549
Provider Second Line Business Mailing Address:
VILLAS DE PIEDRAS BLANCAS
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-669-5567
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA 111 KM 2.9 AVE LOS PATRIOTAS
Provider Second Line Business Practice Location Address:
LARES MEDICAL CENTER
Provider Business Practice Location Address City Name:
LARES
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-897-1444
Provider Business Practice Location Address Fax Number:
787-897-1463
Provider Enumeration Date:
05/25/2007

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: 208D00000X , with the licence number:  9223 , 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: 20049 . This is a "SSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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