MEDICARE: DR. DANIEL MIGUEL BETHENCOURT M.D.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	C41588	CA

General Provider Information

NPI Number	:	1437163904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MIGUEL BETHENCOURT M.D.

Provider Business Mailing Address
First Line	:	17360 BROOKHURST ST
Second Line	:	ATTN: MCMF- CREDENTIALING DEPARTMENT
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2865 ATLANTIC AVE
Second Line	:	SUITE 205
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1740
Country	:	US
Telephone Number	:	562-988-9333
Fax Number	:	562-424-1228

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/23/2016

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