MEDICARE: MARIA I BETANCOURT PA

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	363A00000X	Physician Assistant	PA10412	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA10412	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1386854677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA I BETANCOURT PA

Provider Business Mailing Address
First Line	:	5385 FRANKLIN BLVD STE K
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-4717
Country	:	US
Telephone Number	:	916-428-0656
Fax Number	:	916-428-3763

Provider Business Practice Location Address
First Line	:	5385 FRANKLIN BLVD STE K
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-4717
Country	:	US
Telephone Number	:	916-428-0656
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/17/2009

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Directions to “ MARIA I BETANCOURT PA” Practice Location

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