MEDICARE: MRS. MIRIAM S BETTENCOURT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	10084	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013934967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRIAM S BETTENCOURT MD

Provider Business Mailing Address
First Line	:	9097 W POST RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2417
Country	:	US
Telephone Number	:	702-430-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	6170 N DURANGO DR STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3926
Country	:	US
Telephone Number	:	702-430-5333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	01/19/2023

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