Healthcare Provider Details

I. General information

NPI: 1730711201
Provider Name (Legal Business Name): JOSE J. BETANCOURT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SCHOOL OF MEDICINE, PASEO DR. JOSE CELSO BARBOSA
SAN JUAN PR
00921
US

IV. Provider business mailing address

QUINTAS DEL REY, STREET-NORUEGA, #119
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-519-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23827
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23827
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: