Healthcare Provider Details

I. General information

NPI: 1366154973
Provider Name (Legal Business Name): JEANLOUIS BETANCOURT GAZTAMBIDE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA CARIBBEAN HEALTHCARE SYSTEM 10 CASIA STREET
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 9030
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-6900
  • Fax:
Mailing address:
  • Phone: 787-925-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8104
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number8104
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: