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General NPI Number Information
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NPI Number | 1346032802
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Entity Type | Individual
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Provider Name | LUZ OMAIRA BETANCUR CHW
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Gender | Female
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 375 TIOGUE AVE SIDE DOOR
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City | COVENTRY
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State | RI
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Zip | 02816-7114
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Country | US
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Telephone | 401-617-8489
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Fax |
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Provider Business Mailing Address
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Address Line | 1643 WARWICK AVE STE 200
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City | WARWICK
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State | RI
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Zip | 02889-1525
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Country | US
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Telephone | 401-617-8489
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 200350
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License Number State | RI
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