MEDICARE: AIMEE MARGARITA BETANCOURT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063178226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE MARGARITA BETANCOURT

Provider Business Mailing Address
First Line	:	13453 NETZLEY PL
Second Line	:
City	:	CHINO
State	:	CA
Zip	:	91710-4741
Country	:	US
Telephone Number	:	909-536-5515
Fax Number	:

Provider Business Practice Location Address
First Line	:	6117 BROCKTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2232
Country	:	US
Telephone Number	:	951-481-6402
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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