Healthcare Provider Details

I. General information

NPI: 1255868030
Provider Name (Legal Business Name): LESBIA BETANCOURT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 CALLE LABRADOR
SAN JUAN PR
00924-1764
US

IV. Provider business mailing address

911 CALLE LABRADOR
SAN JUAN PR
00924-1764
US

V. Phone/Fax

Practice location:
  • Phone: 787-963-0171
  • Fax:
Mailing address:
  • Phone: 787-963-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number3906
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number3906
License Number StatePR

VIII. Authorized Official

Name: LESBIA BETANCOURT
Title or Position: CLINICAL SOCIAL WORK
Credential: MSW
Phone: 787-963-0171