Healthcare Provider Details

I. General information

NPI: 1902965841
Provider Name (Legal Business Name): ANDRES BETTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANDRES BETKOWSKY MD

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CAMINO DE LOS MARES SUITE 202
SAN CLEMENTE CA
92673-2859
US

IV. Provider business mailing address

665 CAMINO DE LOS MARES SUITE 202
SAN CLEMENTE CA
92673-2859
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-8959
  • Fax: 949-218-1557
Mailing address:
  • Phone: 949-364-8959
  • Fax: 949-218-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG55823
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG56823
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: