Healthcare Provider Details

I. General information

NPI: 1285616516
Provider Name (Legal Business Name): MARIA LOURDES BETANCOURT-PINEIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB LANDRAU 1411 CARR 21
RIO PIEDRAS PR
00921-3408
US

IV. Provider business mailing address

PO BOX 270334
SAN JUAN PR
00927-0334
US

V. Phone/Fax

Practice location:
  • Phone: 787-793-3095
  • Fax: 787-782-9368
Mailing address:
  • Phone: 787-793-3095
  • Fax: 787-782-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number6418
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number6418
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number6418
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: