Healthcare Provider Details

I. General information

NPI: 1235286014
Provider Name (Legal Business Name): DANIEL M.BETHENCOURT, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 ATLANTIC AVE SUITE 205
LONG BEACH CA
90806-1740
US

IV. Provider business mailing address

2865 ATLANTIC AVE SUITE 205
LONG BEACH CA
90806-1740
US

V. Phone/Fax

Practice location:
  • Phone: 562-988-9333
  • Fax:
Mailing address:
  • Phone: 562-988-9333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC41588
License Number StateCA

VIII. Authorized Official

Name: MRS. TRUDY MACKEL
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 562-988-9333