Healthcare Provider Details

I. General information

NPI: 1245689876
Provider Name (Legal Business Name): AMANDA JEANETTE BETANCOURT-CORTEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 CAMDEN ST STE 300
SAN ANTONIO TX
78215-1610
US

IV. Provider business mailing address

607 CAMDEN ST STE 300
SAN ANTONIO TX
78215-1610
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax:
Mailing address:
  • Phone: 210-253-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10638
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: