MEDICARE: MANUEL P BETANCOURT RUBIO

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	106S00000X	Behavior Technician

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	:	1043861834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANUEL P BETANCOURT RUBIO

Provider Business Mailing Address
First Line	:	14540 PIERCE ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-7524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 DOUGLAS ROAD
Second Line	:	SUIT 230
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4413
Country	:	US
Telephone Number	:	844-854-1116
Fax Number	:

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

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	01/30/2023

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