Healthcare Provider Details

I. General information

NPI: 1497001663
Provider Name (Legal Business Name): GABRIEL BETANCOURT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE 250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

3301 COLLEGE AVE NSU UNIVERSITY CENTER, ROOM 1433
DAVIE FL
33314-7721
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-4645
  • Fax: 855-855-2792
Mailing address:
  • Phone: 954-262-5590
  • Fax: 954-262-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS11826
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 11826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: