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NPI Code Detail

MEDICARE: KYLE RICHARD SALVADOR BETANCOURT

MEDICARE: KYLE RICHARD SALVADOR 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063368421
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE RICHARD SALVADOR BETANCOURT
Provider Business Mailing Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0002
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 200 ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0001
Country : US
Telephone Number : 507-284-2511
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ KYLE RICHARD SALVADOR BETANCOURT ” Practice Location

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