=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942188388
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBEN BETANCOURT CAMPOS BA IN PSYCHOLOGY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 VICKIE AVE
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-361-7753
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 909 N BROADWAY APT 15
-----------------------------------------------------
City | SANTA MARIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93454-3131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-406-6189
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | DB6F86480F
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------