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General NPI Number Information
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NPI Number | 1568767267
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Entity Type | Individual
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Provider Name | RACHAEL MARIE BETTENCOURT PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 5901 HARPER DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3589
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Country | US
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Telephone | 505-823-8282
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Fax | 505-823-8275
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PRESBYTERIAN HEALTHCARE SERVICES - PROVIDER ENROLLMENT
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 9105626
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2011-0004
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License Number State | NM
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