Healthcare Provider Details

I. General information

NPI: 1073080842
Provider Name (Legal Business Name): CLAIRE E BETTENCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 MAGAZINE ST
VALLEJO CA
94590-7798
US

IV. Provider business mailing address

1310 CLUB DR
VALLEJO CA
94592-1187
US

V. Phone/Fax

Practice location:
  • Phone: 707-638-5970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: