=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366392219
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR RAFAEL D BETANCOURT GARCIA (HEMA-ONCO) LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2026
-----------------------------------------------------
Last Update Date | 01/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 735 AVE PONCE DE LEON
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00917-5022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-296-8394
-----------------------------------------------------
Fax | 888-800-4139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2199
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00970-2199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-296-8394
-----------------------------------------------------
Fax | 888-800-4139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. RAFAEL DOEL BETANCOURT GARCIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-296-8394
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QI0500X
-----------------------------------------------------
Taxonomy Name | Infusion Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------