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General NPI Number Information
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NPI Number | 1073252862
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Entity Type | Individual
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Provider Name | FABIOLA MICHELLE BETANCOURT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1115 AVE 65 INFANTERIA
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City | SAN JUAN
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State | PR
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Zip | 00924-3489
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Country | US
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Telephone | 787-768-4700
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Fax |
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Provider Business Mailing Address
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Address Line | VALLE ESCONDIDO 232 MIOSOTIS
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-564-0636
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 8270
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License Number State | PR
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