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General NPI Number Information
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NPI Number | 1780779371
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Entity Type | Individual
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Provider Name | NELHS BETANCOURT MD, MPH, DABT
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 770 MAGNOLIA AVE SUITE 2K
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City | CORONA
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State | CA
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Zip | 92879-3120
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Country | US
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Telephone | 951-898-6600
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Fax | 951-898-7647
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Provider Business Mailing Address
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Address Line | 770 MAGNOLIA AVE SUITE 2K
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City | CORONA
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State | CA
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Zip | 92879-3120
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Country | US
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Telephone | 951-898-6600
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Fax | 951-898-7647
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G71771
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number | G71771
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G71771
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License Number State | CA
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